Prediction of aphasia, quality of life, and cognitive function outcomes using low-frequency transcranial magnetic stimulation in post-stroke non-fluent aphasia

Background Aphasia is a common consequence of stroke that significantly impairs language abilities and quality of life (QOL). Among its subtypes, non-fluent aphasia is particularly associated with more severe communication difficulties and reduced QOL. Low-frequency repetitive transcranial magnetic stimulation (rTMS) has emerged as a potential neuromodulator therapy to facilitate language recovery by modulating cortical activity.Objectives This study aims to evaluate the effects of low frequency rTMS over the right inferior frontal gyrus on language function, cognitive performance, and QOL in patients with chronic post-stroke non-fluent aphasia, as well as to assess the predictive value of rTMS outcomes.Methods A randomized, case-controlled study was conducted involving 30 adult patients with chronic post-stroke non-fluent aphasia. Participants were randomly assigned to an active rTMS group or a sham stimulation group, both receiving standard care, which included routine post-stroke medical management and follow-up without concurrent speech-and-language therapy. Language function was assessed using the Comprehensive Aphasia Test (CAT), cognitive performance via the Montreal Cognitive Assessment (MoCA), and QOL through the Stroke Specific Quality of Life Scale (SSQOL). Stimulation parameters, timing, and adjunctive therapies were standardized. Outcomes were measured pre- and post-intervention, with follow-up assessments to evaluate persistence of effects.Results No significant differences were found between the rTMS and sham groups in overall language or cognitive scores. The sham group performed higher in some language domains at baseline, and these differences persisted post-intervention. Within-group analysis revealed a modest improvement in QOL scores in the rTMS group (p < 0.01). Correlation analysis revealed significant positive associations between improvements in language domains and SSQOL scores (r ranging from 0.549 to 0.737, p < 0.05). Cognitive performance remained largely unchanged across groups.Conclusion Low frequency rTMS over the right inferior frontal gyrus did not produce significant improvements in language or cognitive function compared with sham stimulation. A small within-group increase in QOL scores was observed in the rTMS group, but this should be interpreted cautiously given the absence of corresponding language or cognitive effects. Larger, rigorously controlled studies are warranted to confirm these findings.