Efficacy of Intermittent Theta-Burst Stimulation and Transcranial Direct Current Stimulation in Treatment of Post-Stroke Cognitive Impairment

Abstract

Background:The efficacy of intermittent theta-burst stimulation (iTBS) and transcranial direct current stimulation (tDCS) combined with cognitive training in the treatment of post-stroke cognitive impairment (PSCI) requires further investigation. Methods: We randomly assigned 60 patients with PSCI to receive iTBS (n = 21), tDCS (n = 19), or cognitive training alone (n = 20). Cognitive function was evaluated by the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), and the performance of activities of daily living (ADL) was assessed with the modified Barthel Index (MBI). Of these patients, 14 participated in the functional near-infrared spectroscopy (fNIRS) measurement. Results: After six weeks of treatment, cognitive function improved in all three groups of PSCI patients. Compared with patients receiving only cognitive training, the cognitive function of patients in the iTBS combined with cognitive training (p = 0.003) and tDCS combined with cognitive training groups (p = 0.006) showed greater improvement. The cognitive improvement from tDCS was related to the activation of the frontopolar cortex (FPC), while the improvement of cognition by iTBS was based on the activation of the stimulation site (the dorsolateral prefrontal cortex) and some distant regions. Conclusions: Both iTBS and tDCS in addition to cognitive training appear to improve cognitive function and quality of life of patients with PSCI, compared to cognitive training alone. tDCS improved cognitive function by improving the patient's valuation, motivation, and decision-making substructures, while iTBS improved patients' assessment and decision-making abilities, improving cognitive control and, ultimately, overall cognitive function.

Therapeutic effects of repetitive transcranial magnetic stimulation on cognitive impairment in stroke patients: a systematic review and meta-analysis

“…interventions, 39 non-randomized controlled trial studies, and 3 studies unable to retrive with no data. Ultimately, 12 eligible studies were included in this study (Du and Wu, 2005;Fregni et al, 2006;Kim et al, 2010;Lu et al, 2015;Liu, 2017;Liu et al, 2020;Li et al, 2020Li et al, , 2021Li et al, , 2022Tsai et al, 2020;Yin et al, 2020;Chu et al, 2022). One study (Tsai et al, 2020) did not use any of the same outcome indicators as the rest studies, so only 11 studies were included for quantitative analysis (Figure 1).…”

“…The intervention characteristics of rTMS treatment, such as stimulation site, intensity, frequency, number of pulses, and duration, are excerpted in Table 2. In our meta-analysis, five studies (Du and Wu, 2005;Fregni et al, 2006;Kim et al, 2010;Lu et al, 2015;Li et al, 2021) with a total of 112 patients received low-frequency transcranial magnetic stimulation, and 8 studies (Kim et al, 2010;Liu, 2017;Liu et al, 2020;Li et al, 2020Li et al, , 2022Tsai et al, 2020;Yin et al, 2020;Chu et al, 2022) with a total of 159 patients received high-frequency transcranial magnetic stimulation.…”

“…Two studies (Lu et al, 2015;Chu et al, 2022) rated the degree of loss of cognitive function in patients using the LOTCA scale. And by calculating the heterogeneity between studies, I 2 < 50%, so a fixed-effects model was used for data analysis.…”

“…The first systematic review and meta-analysis with a small sample size was published in 2021 (Higgins et al, 2003) and found that rTMS have a positive effect on improving the cognitive ability of stroke patients. Recently, six new RCTs (Guyatt et al, 2011;Mercuri et al, 2018;Cumpston et al, 2019;Yin et al, 2020;Li et al, 2021Li et al, , 2022Chu et al, 2022) have been published. As a result, an updated systematic review and meta-analysis is needed to provide highquality evidence about the effect of rTMS on PSCI.…”

Efficacy of scalp stimulation for multidomain cognitive impairment in patients with post‐stroke cognitive impairment and dementia: A network meta‐analysis and meta‐regression of moderators

“…An RCT demonstrated that intermittent TBS (iTBS) improved cognitive function by improving assessment and decision-making abilities and that DCS improved valuation, decisionmaking substructures, and motivation. 14 However, study found that routine treatment with EA or transcutaneous electrical nerve stimulation (TENS) was not warranted for enhancing cognitive function in the subacute stroke phase 18 . At the same time, another RCT on tDCS demonstrated a beneficial effect on spatial neglect.…”