Cognitive reserve in the recovery and rehabilitation of stroke and traumatic brain injury: A systematic review.

Objective: Cognitive reserve (CR) is the brain's ability to cope with changes related to aging and/or disease. Originally introduced to explain individual differences in the clinical manifestations of dementia, CR has recently emerged as a relevant construct in stroke and traumatic brain injury (TBI). This systematic review aims to investigate whether CR could predict post-stroke and TBI clinical recovery and rehabilitation outcomes, and how different variables used to estimate CR (i.e., proxies) are related to the prognosis and effectiveness of rehabilitation in these clinical populations. Method: A search was made in Pubmed, Embase, and PsycInfo for articles published until 12 January 2023, following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocol guidelines. Results: 31 studies were included after completing all screening stages. Overall, results show that a higher CR was associated with a better prognosis and a more effective rehabilitation in most of the clinical aspects considered: cognitive functioning, functional, occupational, and socio-emotional abilities, as well as psychiatric and neurological scales. Conclusions: A higher CR seems to be associated with a more favorable prognosis and a better rehabilitation outcome after stroke and TBI. Results suggest that CR should be taken into account in clinical practice to make more accurate predictions about recovery and effectiveness of rehabilitation. However, some inconsistencies suggest the need for further investigations, possibly using multiple proxies for CR.

Comprehensive investigation of predictive processing: A cross- and within-cognitive domains fMRI meta-analytic approach.

Predictive processing (PP) stands as a predominant theoretical framework in neuroscience. While some efforts have been made to frame PP within a cognitive domain-general network perspective, suggesting the existence of a "prediction network," these studies have primarily focused on specific cognitive domains or functions. The question of whether a domain-general predictive network that encompasses all well-established cognitive domains exists remains unanswered. The present meta-analysis aims to address this gap by testing the hypothesis that PP relies on a large-scale network spanning across cognitive domains, supporting PP as a unified account toward a more integrated approach to neuroscience. The Activation Likelihood Estimation meta-analytic approach was employed, along with Meta-Analytic Connectivity Mapping, conjunction analysis, and behavioral decoding techniques. The analyses focused on prediction incongruency and prediction congruency, two conditions likely reflective of core phenomena of PP. Additionally, the analysis focused on a prediction phenomena-independent dimension, regardless of prediction incongruency and congruency. These analyses were first applied to each cognitive domain considered (cognitive control, attention, motor, language, social cognition). Then, all cognitive domains were collapsed into a single, cross-domain dimension, encompassing a total of 252 experiments. Results pertaining to prediction incongruency rely on a defined network across cognitive domains, while prediction congruency results exhibited less overall activation and slightly more variability across cognitive domains. The converging patterns of activation across prediction phenomena and cognitive domains highlight the role of several brain hubs unfolding within an organized large-scale network (Dynamic Prediction Network), mainly encompassing bilateral insula, frontal gyri, claustrum, parietal lobules, and temporal gyri. Additionally, the crucial role played at a cross-domain, multimodal level by the anterior insula, as evidenced by the conjunction and Meta-Analytic Connectivity Mapping analyses, places it as the major hub of the Dynamic Prediction Network. Results support the hypothesis that PP relies on a domain-general, large-scale network within whose regions PP units are likely to operate, depending on the context and environmental demands. The wide array of regions within the Dynamic Prediction Network seamlessly integrate context- and stimulus-dependent predictive computations, thereby contributing to the adaptive updating of the brain's models of the inner and external world.

Aperiodic component of EEG power spectrum and cognitive performance are modulated by education in aging.

Recent studies have shown a growing interest in the so-called "aperiodic" component of the EEG power spectrum, which describes the overall trend of the whole spectrum with a linear or exponential function. In the field of brain aging, this aperiodic component is associated both with age-related changes and performance on cognitive tasks. This study aims to elucidate the potential role of education in moderating the relationship between resting-state EEG features (including aperiodic component) and cognitive performance in aging. N = 179 healthy participants of the "Leipzig Study for Mind-Body-Emotion Interactions" (LEMON) dataset were divided into three groups based on age and education. Older adults exhibited lower exponent, offset (i.e. measures of aperiodic component), and Individual Alpha Peak Frequency (IAPF) as compared to younger adults. Moreover, visual attention and working memory were differently associated with the aperiodic component depending on education: in older adults with high education, higher exponent predicted slower processing speed and less working memory capacity, while an opposite trend was found in those with low education. While further investigation is needed, this study shows the potential modulatory role of education in the relationship between the aperiodic component of the EEG power spectrum and aging cognition.

Mood moderates the effects of prefrontal tDCS on executive functions: A meta-analysis testing the affective state-dependency hypothesis.

BACKGROUND: In recent decades, numerous studies have investigated the effects of transcranial direct current stimulation (tDCS) on cognitive functioning. However, results of these studies frequently display inconsistency and pose challenges regarding replicability. The present work aimed at testing the hypothesis of mood as potential moderator of prefrontal tDCS effects on executive functions (EF). This hypothesis refers to the relationship between mood and EF, as well as to the association of mood with the dorsolateral prefrontal cortex (dlPFC) activity. METHODS: We conducted a meta-analysis of 11 articles where the dlPFC was stimulated with anodal tDCS, EF were measured, and mood was assessed prior to the stimulation. We then conducted a meta-regression to examine whether mood moderated the tDCS effects on EF. RESULTS: While no significant effect of tDCS on EF emerged from the meta-analysis, the meta-regression indicated that mood plays a significant role as moderator, with greater tDCS effects on EF in individuals with higher depressive symptoms. LIMITATIONS: The limited number of studies included, the heterogeneous samples considered, and the limited generalizability to other non-invasive brain stimulation techniques and affective states. CONCLUSIONS: Findings suggest that evaluating mood prior to stimulation could increase the sensitivity and specificity of tDCS application, and provide the first meta-analytic evidence in favor of the affective state-dependency hypothesis.

A meta-analysis of non-invasive brain stimulation (NIBS) effects on cerebellar-associated cognitive processes.

Non-invasive brain stimulation (NIBS) techniques, including transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES), have provided valuable insights into the role of the cerebellum in cognitive processes. However, replicating findings from studies involving cerebellar stimulation poses challenges. This meta-analysis investigates the impact of NIBS on cognitive processes associated with the cerebellum. We conducted a systematic search and analyzed 66 studies and 91 experiments involving healthy adults who underwent either TMS or transcranial direct current stimulation (tDCS) targeting the cerebellum. The results indicate that anodal tDCS applied to the medial cerebellum enhances cognitive performance. In contrast, high-frequency TMS disrupts cognitive performance when targeting the lateral cerebellar hemispheres or when employed in online protocols. Similarly, low-frequency TMS and continuous theta burst stimulation (cTBS) diminish performance in offline protocols. Moreover, high-frequency TMS impairs accuracy. By identifying consistent effects and moderators of modulation, this meta-analysis contributes to improving the replicability of studies using NIBS on the cerebellum and provides guidance for future research aimed at developing effective NIBS interventions targeting the cerebellum.

The mismatch negativity as an index of cognitive abilities in adults with Down syndrome.

Down syndrome (DS) is associated with an ultra-high risk of developing Alzheimer's disease (AD). Understanding variability in pre-AD cognitive abilities may help understand cognitive decline in this population. The mismatch negativity (MMN) is an event-related potential component reflecting the detection of deviant stimuli that is thought to represent underlying memory processes, with reduced MMN amplitudes being associated with cognitive decline. To further understand the MMN in adults with DS without AD, we explored the relationships between MMN, age, and cognitive abilities (memory, language, and attention) in 27 individuals (aged 17-51) using a passive auditory oddball task. Statistically significant MMN was present only in 18 individuals up to 41 years of age and the latency were longer than canonical parameters reported in the literature. Reduced MMN amplitude was associated with lower memory scores, while longer MMN latencies were associated with poorer memory, verbal abilities, and attention. Therefore, the MMN may represent a valuable index of cognitive abilities in DS. In combination with previous findings, we hypothesize that while MMN response and amplitude may be associated with AD-related memory loss, MMN latency may be associated with speech signal processing. Future studies may explore the potential impact of AD on MMN in people with DS.

Addiction as a brain disease? A meta-regression comparison of error-related brain potentials between addiction and neurological diseases.

The notion that addiction is a "brain disorder" is widespread. However, there is a lack of evidence on the degree of disorder in terms of error processing in addiction. The present meta-analysis aimed at shedding light on this by comparing error-processes with populations with well-recognized brain disorders. We included 17 addiction and 32 neurological disorder studies that compared error-related negativity (ERN) or error positivity (Pe) amplitudes/latencies between experimental and healthy-control groups. Meta-regression analyses were performed for the intergroup comparison and other moderators. Both diagnoses were accompanied by a diminished ERN amplitude, although the degree of impairment was marginally larger in neurological disorders. Neurological disorders presented shorter ERN latencies than addiction when compared with controls. The two groups did not differ in Pe amplitude/latency. Except for a reduced ERN amplitude found along with aging, no other moderator contributed significantly to divergent findings about these four ERP indexes. The results support the brain disease model of addiction, while stressing the importance of quantifying the degrees of brain dysfunctions as a next step.

Use of Telemedicine to Improve Cognitive Functions and Psychological Well-Being in Patients with Breast Cancer: A Systematic Review of the Current Literature.

The diagnosis and side effects of breast cancer (BC) treatments greatly affect the everyday lives of women suffering from this disease, with relevant psychological and cognitive consequences. Several studies have reported the psychological effects of receiving a diagnosis of BC. Moreover, women undergoing anticancer therapies may exhibit cognitive impairment as a side effect of the treatments. The access to cognitive rehabilitation and psychological treatment for these patients is often limited by resources; women of childbearing age often encounter difficulties in completing rehabilitation programs requiring access to care institutions. Telemedicine, which provides health services using information and communication technologies, is a useful tool to overcome these limitations. In particular, telemedicine may represent an optimal way to guarantee cognitive rehabilitation, psychological support, and recovery to BC patients. Previous studies have reviewed the use of telemedicine to improve psychological well-being in BC patients, and a few have investigated the effect of telerehabilitation on cognitive deficits. This study systematically reviewed the evidence on the cognitive and psychological effects of telemedicine in BC patients. Current evidence suggests that telemedicine may represent a promising tool for the management of some psychological problems experienced by breast cancer patients, but more controlled studies are needed to clarify its effectiveness, especially for cognitive deficits. The results are also discussed in light of the intervening and modulating factors that may mediate both side effect occurrence and the success of the interventions.

State-dependent tDCS modulation of the somatomotor network: A MEG study.

OBJECTIVE: Transcranial direct current stimulation (tDCS) is a non-invasive technique widely used to investigate brain excitability and activity. However, the variability in both brain and behavioral responses to tDCS limits its application for clinical purposes. This study aims to shed light on state-dependency, a phenomenon that contributes to the variability of tDCS. METHODS: To this aim, we investigated changes in spectral activity and functional connectivity in somatomotor regions after Real and Sham tDCS using generalized additive mixed models (GAMMs), which allowed us to investigate how modulation depends on the initial state of the brain. RESULTS: Results showed that changes in spectral activity, but not connectivity, in the somatomotor regions depend on the initial state of the brain, confirming state-dependent effects. Specifically, we found a non-linear interaction between stimulation conditions (Real vs Sham) and initial state: a reduction of alpha and beta power was observed only in participants that had higher alpha and beta power before Real tDCS. CONCLUSIONS: This study highlights the importance of considering state-dependency to tDCS and shows how it can be taken into account with appropriate statistical models. SIGNIFICANCE: Our findings bear insight into tDCS mechanisms, potentially leading to discriminate between tDCS responders and non-responders.

Disconnection from prediction: A systematic review on the role of right temporoparietal junction in aberrant predictive processing.

The right temporoparietal junction (rTPJ) is a brain area that plays a critical role in a variety of cognitive functions. Although different theoretical proposals tried to explain the ubiquitous role of rTPJ, recent evidence suggests that rTPJ may be a fundamental cortical region involved in different kinds of predictions. This systematic review aims to better investigate the potential role of rTPJ under a predictive processing perspective, providing an overview of cognitive impairments in neurological patients as the consequence of structural or functional disconnections or damage of rTPJ. Results confirm the involvement of rTPJ across several tasks and neurological pathologies. RTPJ, via its connections with other brain networks, would integrate diverse information and update internal models of the world. Against traditional views, which tend to focus on distinct domains, we argue that the role of rTPJ can be parsimoniously interpreted as a key hub involved in domain-general predictions. This alternative account of rTPJ role in aberrant predictive processing opens different perspectives, stimulating new hypotheses in basic research and clinical contexts.

Speech Fluency Improvement in Developmental Stuttering Using Non-invasive Brain Stimulation: Insights From Available Evidence.

Developmental stuttering (DS) is a disturbance of the normal rhythm of speech that may be interpreted as very debilitating in the most affected cases. Interventions for DS are historically based on the behavioral modifications of speech patterns (e.g., through speech therapy), which are useful to regain a better speech fluency. However, a great variability in intervention outcomes is normally observed, and no definitive evidence is currently available to resolve stuttering, especially in the case of its persistence in adulthood. In the last few decades, DS has been increasingly considered as a functional disturbance, affecting the correct programming of complex motor sequences such as speech. Compatibly, understanding of the neurophysiological bases of DS has dramatically improved, thanks to neuroimaging, and techniques able to interact with neural tissue functioning [e.g., non-invasive brain stimulation (NIBS)]. In this context, the dysfunctional activity of the cortico-basal-thalamo-cortical networks, as well as the defective patterns of connectivity, seems to play a key role, especially in sensorimotor networks. As a consequence, a direct action on the functionality of "defective" or "impaired" brain circuits may help people who stutter to manage dysfluencies in a better way. This may also "potentiate" available interventions, thus favoring more stable outcomes of speech fluency. Attempts aiming at modulating (and improving) brain functioning of people who stutter, realized by using NIBS, are quickly increasing. Here, we will review these recent advancements being applied to the treatment of DS. Insights will be useful not only to assess whether the speech fluency of people who stutter may be ameliorated by acting directly on brain functioning but also will provide further suggestions about the complex and dynamic pathophysiology of DS, where causal effects and "adaptive''/''maladaptive" compensation mechanisms may be strongly overlapped. In conclusion, this review focuses future research toward more specific, targeted, and effective interventions for DS, based on neuromodulation of brain functioning.

Novel insights into the relationship between cerebellum and dementia: A narrative review as a toolkit for clinicians.

The role of the cerebellum in neurodegenerative disorders that target cognitive functions has been a subject of increasing interest over the past years. However, a review focused on making clinicians more aware of the role of the cerebellum in dementia is still missing. This narrative review explores the possible factors explaining the involvement of the cerebellum in different kinds of dementia by providing more insights on how this structure can be relevant in clinical practice. It emerged that, despite overlapping in specific areas, structural cerebellar alterations in dementia show a certain degree of disease-specificity. Furthermore, the relevance of cerebellar changes in dementia is corroborated by correlations observed between their topography and cognitive symptomatology, as well as by its previously ignored involvement of the cerebellum in early stages of dementia. Despite needing further investigations, these findings could become a useful diagnostic aid for clinicians that should not be overlooked, in particular for those individuals who do not show distinct and manifest brain or neuropsychological alterations, but that still make clinicians suspect the presence of a neurocognitive disease.

Neurophysiological and behavioural effects of conventional and high definition tDCS.

High-definition transcranial direct current stimulation (HD-tDCS) seems to overcome a drawback of traditional bipolar tDCS: the wide-spread diffusion of the electric field. Nevertheless, most of the differences that characterise the two techniques are based on mathematical simulations and not on real, behavioural and neurophysiological, data. The study aims to compare a widespread tDCS montage (i.e., a Conventional bipolar montage with extracephalic return electrode) and HD-tDCS, investigating differences both at a behavioural level, in terms of dexterity performance, and a neurophysiological level, as modifications of alpha and beta power as measured with EEG. Thirty participants took part in three sessions, one for each montage: Conventional tDCS, HD-tDCS, and sham. In all the conditions, the anode was placed over C4, while the cathode/s placed according to the montage. At baseline, during, and after each stimulation condition, dexterity was assessed with a Finger Tapping Task. In addition, resting-state EEG was recorded at baseline and after the stimulation. Power spectrum density was calculated, selecting two frequency bands: alpha (8-12 Hz) and beta (18-22 Hz). Linear mixed effect models (LMMs) were used to analyse the modulation induced by tDCS. To evaluate differences among the montages and consider state-dependency phenomenon, the post-stimulation measurements were covariate-adjusted for baseline levels. We observed that HD-tDCS induced an alpha power reduction in participants with lower alpha at baseline. Conversely, Conventional tDCS induced a beta power reduction in participants with higher beta at baseline. Furthermore, data showed a trend towards a behavioural effect of HD-tDCS in participants with lower beta at baseline showing faster response times. Conventional and HD-tDCS distinctively modulated cortical activity. The study highlights the importance of considering state-dependency to determine the effects of tDCS on individuals.

Acetylcholinesterase inhibitors and cognitive stimulation, combined and alone, in treating individuals with mild Alzheimer's disease.

BACKGROUNDS: Acetylcholinesterase inhibitors (AChEI) and cognitive stimulation (CS) are the standard pharmacological and non-pharmacological treatments for Alzheimer's disease (AD). AIMS: The aim of this study was to investigate the effects of these treatments, alone or combined, on the neuropsychological profiles of patients with AD. METHODS: Forty participants were assigned to three groups receiving either only AChEI (n = 14), AChEI + CS (n = 15), or only CS (n = 11). Cognition was evaluated at baseline and after three months. Linear mixed-effects models were used to investigate differences among the treatments in terms of changes in the patients' neuropsychological profiles. RESULTS: Results, although preliminary because of the small sample size, suggest that a general improvement was found in patients who received AChEI + CS and those who received only CS compared with those who received only AChEI. Interestingly, individuals who received only CS showed a significant improvement in immediate memory recall than those who received only AChEI. Furthermore, the group receiving AChEI + CS showed an improvement in delayed recall than the other two groups. DISCUSSION: The combination of AChEI and CS seems to have the greatest benefit for patients with mild AD. More interestingly, CS alone is more effective than AChEI alone, even in improving memory, considered to be the "lost" cognitive domain in AD.

The Role of Motivation and Anxiety on Error Awareness in Younger and Older Adults.

Aging is associated with several changes in cognitive functions, as well as in motivational and affective processes, which in turn interact with cognitive functions. The present study aimed to investigate error awareness (EA), which declines with aging, in relation to motivation and anxiety. Adopting an experimental task, we firstly tested the hypothesis that EA could be enhanced through reward motivation. Secondly, we explored the relation between state and trait anxiety and EA, investigating the hypothesis of an association between EA and anxiety, and between anxiety and the potential benefit of motivation on EA. Thirty healthy younger (age range: 19-35 years; mean age 25.4 ± 5.1; 10 M) and 30 healthy older adults (age range: 61-83 years; mean age 69.7 ± 5.5; 12 M) took part in the study and performed both the classic Error Awareness Task (EAT) and one experimental task, called the Motivational EAT. In this new task, motivational incentives were delivered after aware correct responses and aware errors. For every participant, standard measures of state and trait anxiety and cognitive functions were collected. Confirming the presence of a significant age-related EA decline, results did not reveal any influence of reward motivation on EA, nor any relation between EA and anxiety. However, both younger and older adults had longer response times (RTs) and made more errors during the Motivational EAT, with the more anxious participants showing the greater RT slowing. Findings suggest that reward motivation might not be always beneficial for cognitive performance, as well as that anxiety does not relate to EA capacity. Results also recommend further investigation, as well as the assessment of EA in patients with either motivational deficits like apathy, and/or with anxiety disorders.

Investigating the Accessibility of Voice Assistants With Impaired Users: Mixed Methods Study.

BACKGROUND: Voice assistants allow users to control appliances and functions of a smart home by simply uttering a few words. Such systems hold the potential to significantly help users with motor and cognitive disabilities who currently depend on their caregiver even for basic needs (eg, opening a door). The research on voice assistants is mainly dedicated to able-bodied users, and studies evaluating the accessibility of such systems are still sparse and fail to account for the participants' actual motor, linguistic, and cognitive abilities. OBJECTIVE: The aim of this work is to investigate whether cognitive and/or linguistic functions could predict user performance in operating an off-the-shelf voice assistant (Google Home). METHODS: A group of users with disabilities (n=16) was invited to a living laboratory and asked to interact with the system. Besides collecting data on their performance and experience with the system, their cognitive and linguistic skills were assessed using standardized inventories. The identification of predictors (cognitive and/or linguistic) capable of accounting for an efficient interaction with the voice assistant was investigated by performing multiple linear regression models. The best model was identified by adopting a selection strategy based on the Akaike information criterion (AIC). RESULTS: For users with disabilities, the effectiveness of interacting with a voice assistant is predicted by the Mini-Mental State Examination (MMSE) and the Robertson Dysarthria Profile (specifically, the ability to repeat sentences), as the best model shows (AIC=130.11). CONCLUSIONS: Users with motor, linguistic, and cognitive impairments can effectively interact with voice assistants, given specific levels of residual cognitive and linguistic skills. More specifically, our paper advances practical indicators to predict the level of accessibility of speech-based interactive systems. Finally, accessibility design guidelines are introduced based on the performance results observed in users with disabilities.

Repetitive TMS over the left dorsolateral prefrontal cortex modulates the error positivity: An ERP study.

Error processing is a critical step towards an efficient adaptation of our behavior to achieve a goal. Little research has been devoted to investigate the contribution of the dorsolateral prefrontal cortex (DLPFC) in supporting error processing. In this study, the causal relationship of the DLPFC in error commission was examined by means of a repetitive transcranial magnetic stimulation protocol (rTMS). Specifically, the effects of an inhibitory protocol were assessed by examining the electroencephalographic signal recorded during the execution of a Go/No-Go task. To this aim, a group of 15 healthy young participants performed a three-session study. At each session, either the right DLPFC, the left DLPFC, or the Vertex (control site) were stimulated, for 20 min at 1 Hz. Immediately after the stimulation, participants performed the task. Although no behavioral effects of rTMS emerged, the analysis of event-related electric potentials (ERPs) revealed that the amplitude of a positive potential evoked by error commission, the error positivity (Pe), was reduced after the stimulation of the left DLPFC. On the contrary, the earlier error-related negativity component (ERN) was not affected. These results revealed that the left DLPFC intervenes at later stages of error-related processes. We could speculate that its role is specifically linked to error awareness.

Intra-Individual Variability of Error Awareness and Post-error Slowing in Three Different Age-Groups.

Background: Error awareness (EA) and post-error slowing (PES) are two crucial components of an adequate performance monitoring because, respectively, they allow being aware of an error and triggering performance adjustments following unexpected events. Objective: The purpose of the present study was to investigate the ontogenetic trajectories of EA and PES, as well as to examine how EA and PES interact with each other. Methods: The performance of three groups of participants (children, younger, and older adults) in a modified version of the Error Awareness task (EAT; Hester et al., 2005) was compared. In particular, in this study not only variations of the average performance were examined, but also intra-individual variability (IIV), considered in terms of variations of SD and ex-Gaussian parameters (mu, sigma, and tau). Results: Two distinct ontogenetic trajectories of EA and PES were observed. Regarding EA, we observe a U-shaped curve that describes an increase of the process from childhood to early adulthood and a progressive reduction advancing age in late adulthood. Furthermore, a greater IIV in older adults indicated a susceptibility of EA to the aging process. The ontogenetic trajectory of PES seems substantially different from the trajectory that describes EA since in PES we do not observe age-related differences. Conclusion: These results suggest that EA and PES are two independent processes. Furthermore, it appears that EA and PES are differently prone to short-term fluctuations in performance across the lifespan. While EA presents an increase in IIV in aging, PES seems to be immune to these changes.

Possible Role of Dorsolateral Prefrontal Cortex in Error Awareness: Single-Pulse TMS Evidence.

Background: Error awareness is essential to maintain an adaptive and goal-directed behavior and is supposed to rely on the activity of the right dorsolateral prefrontal cortex (DLPFC). However, studies employing electrophysiological methods and functional resonance imaging (fMRI) do not allow to establish a causal relationship between error awareness and implicated brain structures. Objective: The study examined the causal relationship between DLPFC activity and error awareness in order to confirm the involvement of the right DLPFC in error awareness and to obtain temporal information about this process, namely when the activity of the right DLPFC is involved in error awareness. Methods: Three experiments with three different samples were conducted employing on-line Transcranial Magnetic Stimulation (TMS). A paired-pulse and a single-pulse on-line TMS paradigm were employed respectively in Experiments 1 and 3, whereas in Experiment 2 a control test was conducted without TMS. In TMS experiments, the right DLPFC was stimulated, considering the left DLPFC and the Vertex as control sites. Results: Experiment 1 showed no effect of paired-pulse TMS over either right or left DLPFC on error awareness. In Experiment 3, independently from the time point during which TMS was delivered, results showed a significant effect of single-pulse TMS over the DLPFC on Stroop Awareness, without evidence for lateralization of the process. Conclusions: Results of the present study partially demonstrate the involvement of the DLPFC in error awareness.