Mental health does not exist apart from the rest of the brain and body. Research increasingly shows that Depression, cognitive decline, and neurological conditions share overlapping biological pathways, and overlapping risk factors. A recent systematic review published in the Journal of Neurology, Neurosurgery & Psychiatry (JNNP) identifies modifiable risk factors that influence the development of stroke, dementia, and late-life Depression, adding to a growing body of research on TMS and brain health.
For patients and clinicians, this research carries an encouraging message: many of the risks associated with Depression and cognitive decline are not fixed. They can be addressed, and in some cases reversed. For patients considering treatments such as transcranial magnetic stimulation (TMS), this research strengthens the case for viewing TMS and brain health as closely connected, supporting more comprehensive care.
The Overlap Between Depression and Brain Disease
Depression has traditionally been treated as a psychiatric condition, while stroke and dementia are categorized as neurological disorders. Current research challenges that separation. The JNNP study finds that late-life Depression often shares risk pathways with both stroke and dementia, which suggests the conditions are interconnected rather than independent. This overlap shows up clinically in several ways:
- Depression can precede dementia by years
- Stroke survivors frequently develop Depression
- Chronic Depression is associated with increased cognitive decline
These patterns likely reflect shared biological mechanisms, including vascular health, inflammation, and neurodegeneration. For patients with treatment-resistant Depression, this reinforces an important point: treating Depression effectively is not only about mood. It may also help protect long-term brain health.
What Are Modifiable Risk Factors?
A central focus of the JNNP study is the concept of modifiable risk factors: lifestyle, medical, or environmental factors that patients and clinicians can actively change. Unlike age or genetics, these risks represent real opportunities for intervention. The study weighted each risk factor using a Disability-Adjusted Life Years (DALY) approach, which estimates how much a given factor contributes to overall disease burden across stroke, dementia, and Depression. This method helps identify which interventions are likely to have the greatest real-world effect.
The Most Significant Modifiable Risk Factors
The findings point to several key contributors to brain health outcomes. While stroke, dementia, and Depression each have distinct features, many of the most influential risks overlap across all three.
Cardiovascular and metabolic health. Hypertension, diabetes, and high cholesterol all affect blood flow to the brain, contributing to stroke risk, vascular dementia, and structural brain changes linked to Depression. The brain depends on a steady blood supply, and even modest impairments in vascular function can affect mood regulation and cognitive processing.
Lifestyle factors. Physical inactivity, poor diet, smoking, and excess alcohol use were among the most significant modifiable risks identified. These behaviors affect cardiovascular health as well as inflammation, neuroplasticity, and neurotransmitter systems. Regular physical activity, for example, has been shown to support neurogenesis and mood regulation, effects that may complement treatments like TMS.
Social and psychological factors. Social isolation, low educational attainment, and chronic stress can increase vulnerability to both Depression and cognitive decline. This points to the value of treating the whole patient rather than symptoms alone. Psychosocial support, therapy, and community engagement remain essential parts of care.
Sensory and neurological health. Hearing loss and other sensory impairments were linked to dementia risk and, potentially, Depression, likely because they reduce social engagement and increase cognitive load. Addressing these issues early, through hearing aids or medical care, can meaningfully affect mental health outcomes down the line.
Why This Matters for Depression Treatment
For patients with Major Depressive Disorder (MDD), particularly those who have not responded to medication, this research places the condition within a broader brain health picture. Depression is not simply a matter of brain chemistry. It often involves network-level dysfunction in the brain, reduced neuroplasticity, and interaction with systemic health factors.
TMS and Brain Health: Restoring Network Function
TMS is a non-invasive, FDA-cleared treatment for Depression that works by directly stimulating targeted brain regions involved in mood regulation. Unlike medications, which act throughout the body, TMS targets specific neural circuits, supports neuroplasticity, and helps regulate dysfunctional brain networks. This is particularly relevant given the JNNP findings. If Depression shares pathways with vascular and neurodegenerative processes, treatments that restore brain network function may offer benefits beyond mood alone, including improved cognitive function and greater brain resilience. TMS is not a treatment for dementia or stroke, but its ability to strengthen neural connectivity is a clear example of the link between TMS and brain health, supporting the broader goal of long-term wellness.
A Comprehensive Approach to Treatment
The central lesson of the JNNP study is that effective mental health care works best as part of a broader plan. For patients undergoing TMS, outcomes tend to improve when neuromodulation is paired with targeted lifestyle and medical care. Practical steps patients can take alongside treatment include:
- Optimize physical health by managing blood pressure, cholesterol, and blood sugar with a primary care provider
- Stay physically active through regular aerobic exercise, which supports both mood and cognition
- Improve sleep quality, since sleep is essential for brain repair and emotional regulation
- Address social isolation by maintaining meaningful relationships and community engagement
- Reduce substance use, including limiting alcohol and avoiding smoking
- Engage in cognitive stimulation through reading, learning, and problem-solving
These steps are not a substitute for medical treatment, but they can meaningfully support its effectiveness.
Prevention and Early Intervention
One of the most important implications of this research is the opportunity for prevention. Addressing modifiable risk factors early may reduce the likelihood of developing Depression, delay or prevent cognitive decline, and improve long-term quality of life. For patients with a history of Depression, particularly late-life Depression, proactive management of these factors becomes even more important.
What This Means for Patients
Depression, dementia, and stroke are closely connected conditions with shared, modifiable risk factors. The encouraging takeaway from current research is that many of these risks can be addressed through targeted intervention. For patients with Depression, especially treatment-resistant Depression, this means there is more than one path toward recovery. TMS offers an evidence-based option for directly improving brain function, and when combined with attention to overall health, it becomes part of a comprehensive strategy to treat Depression while supporting long-term cognitive and neurological health.
At Mid City TMS, this integrated perspective guides our care: treating Depression effectively while helping patients build a healthier, more resilient brain for the future. The connection between TMS and brain health continues to grow stronger as research advances, and we stay current with these findings to inform every patient’s treatment plan. Learn how Mid City TMS can help and contact us today to schedule a consultation.
Sources
- Logroscino GPreventing one disease is not enough for brain healthJournal of Neurology, Neurosurgery & Psychiatry 2025;96:513. https://doi.org/10.1136/jnnp-2025-335858
- Kim, Y. E., Jung, Y. S., Ock, M., & Yoon, S. J. (2022). DALY Estimation Approaches: Understanding and Using the Incidence-based Approach and the Prevalence-based Approach. Journal of preventive medicine and public health = Yebang Uihakhoe chi, 55(1), 10–18. https://doi.org/10.3961/jpmph.21.597