Repetitive transcranial magnetic stimulation combined with cognitive training for cognitive function and activities of daily living in patients with post-stroke cognitive impairment: A systematic review and meta-analysis

Gao, Yong; Qiu, Yudong; Yang, Qi; Tang, Shaowen; Gong, Jianqiu; Hong, Fan; Wu, Yuefeng; Lu, Xiao

doi:10.1016/j.arr.2023.101919

Cited by 16 publications

(12 citation statements)

References 55 publications

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“…The vital entries reported as missing in large numbers are entry 2 (41%), entry 7 (0%), entry 13 (12%), and entry 15 (41%). The following were the primary causes: (1) only seven ( 36–38 , 40 , 43 , 46 , 47 ) articles were numbered and registered in the program before the evaluation; (2) the reasons for the exclusion list are not provided in all the articles; (3) only two ( 40 , 46 ) articles considered the risk of study bias when discussing or analyzing the results of each study; (4) all articles were searched without consulting experts in the relevant fields; and (5) 10 ( 31 , 33 , 36 , 39–44 , 47 ) articles do not describe the likelihood of the existence of publication bias in the small-sample studies and the severity of their impacts. The non-vital entries reported as missing in large numbers are entry 3 (0%), entry 10 (0%), entry 12 (29%), and entry 14 (47%).…”

Section: Resultsmentioning

confidence: 99%

“…Seventeen articles had a score ranging from 5 to 11. Among them, three ( 33 , 42 , 44 ) studies scored 5, one ( 31 ) literature scored 6, one ( 41 ) literature scored 6.5, four ( 35 , 39 , 43 , 45 ) articles scored 7, one ( 34 ) literature scored 8, one ( 37 ) literature scored 9, three ( 32 , 36 , 40 ) articles scored 10, and three ( 38 , 46 , 47 ) articles scored 11. Refer to Table 2 for details.…”

Section: Resultsmentioning

confidence: 99%

“…Forty sessions of low-frequency stimulation were more effective than 20 or 10 sessions, and 15 sessions of high-frequency stimulation were more productive than 20 or 10 sessions. (5) The effect of stimulation during the acute or subacute phase of stroke is more significant than during the chronic phase, according to the post-stroke duration study ( 40 ). (6) The details of the rTMS treatment regimen, such as the number of sessions, the time between sessions, and the number of pulses in each session, are not well-documented.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of repetitive transcranial magnetic stimulation in post-stroke cognitive impairment: an overview of systematic reviews

Zhang,

Gao,

Wang

et al. 2024

Front. Neurol.

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ObjectiveThe reliability of clinical evidence depends on high-quality meta-analyses/ systematic reviews (MAs/SRs). However, there has been no assessment of the quality of MAs/SRs for repetitive transcranial magnetic stimulation (rTMS) in post-stroke cognitive impairment (PSCI), both nationally and internationally. This article seeks to use radar plotting to visually present the quality of MAs/SRs on rTMS for improving cognitive function in PSCI, aiming to offer an intuitive foundation for clinical research.MethodsEight Chinese or English databases were systematically searched to collect comprehensive literature, and the retrieval time ranged from inception to 26 March 2024. Literature ranking was calculated using six dimensions: publication year, design type, AMSTAR-2 score, PRISMA score, publication bias, and homogeneity. Finally, radar plots were drafted to present a multivariate literature evaluation. The GRADE tool assessed the strength of evidence for the outcome indicators included in the MAs/SRs.ResultsThe 17 articles included had average scores of 12.29, 17, 9.88, 9.71, 12.88, and 12.76 for each dimension. The radar plot showed that an article published in 2023 had the highest rank and a large radar plot area, while an article published in 2021 had the lowest rank and a small radar plot area. The GRADE tool evaluation revealed that 51 pieces of evidence were of very low quality, 67 were of low quality, 12 were of moderate quality, and only one was of high quality.ConclusionThe average rank score of literature ranged from 8.50 to 17, with higher rankings indicating greater significance in literature reference. Variations in literature quality were attributed to inadequate study planning, irregular literature search and screening, insufficient description of inclusion criteria for studies, and inadequate consideration of bias risk in the included studies. Most MAs/SRs indicated that rTMS was more effective than the control group in enhancing the global cognitive function and activities of daily living in PSCI patients. However, the overall quality of the literature was generally low and needs validation from future high-quality evidence.Systematic review registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42023491280.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of repetitive transcranial magnetic stimulation in post-stroke cognitive impairment: an overview of systematic reviews

Zhang,

Gao,

Wang

et al. 2024

Front. Neurol.

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“…In addition, TMS can effectively improve the overall cognitive ability of Parkinson’s disease patients with mild cognitive impairment ( Trung et al, 2019 ). The observation of patients with cognitive impairment after stroke showed that TMS combined with cognitive training had a positive effect on the overall cognition, executive function and working memory of patients ( Gao et al, 2023 ). A meta-analysis suggested that high-frequency TMS in the DLPFC can improve the overall cognitive function of patients with age-related neurodegenerative diseases ( Miller et al, 2023 ).…”

Section: Discussionmentioning

confidence: 99%

Effect of high-frequency repetitive transcranial magnetic stimulation on cognitive impairment in WD patients based on inverse probability weighting of propensity scores

Chen,

Wang,

Zhang

et al. 2024

Front. Neurosci.

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BackgroundHepatolenticular degeneration [Wilson disease (WD)] is an autosomal recessive metabolic disease characterized by copper metabolism disorder. Cognitive impairment is a key neuropsychiatric symptom of WD. At present, there is no effective treatment for WD-related cognitive impairment.MethodsIn this study, high-frequency repetitive transcranial magnetic stimulation (rTMS) was used to treat WD-related cognitive impairment, and inverse probability weighting of propensity scores was used to correct for confounding factors. The Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Auditory Verbal Learning Test (AVLT), Boston Naming Test (BNT), Clock Drawing Test (CDT) and Trail Making Test (TMT) were used to evaluate overall cognition and specific cognitive domains.ResultsThe MMSE, MoCA and CDT scores after treatment were significantly different from those before treatment (MMSE: before adjustment: OR = 1.404, 95% CI: 1.271–1.537; after adjustment: OR = 1.381, 95% CI: 1.265–1.497, p < 0.001; MoCA: before adjustment: OR = 1.306, 95% CI: 1.122–1.490; after adjustment: OR = 1.286, 95% CI: 1.104; AVLT: OR = 1.161, 95% CI: 1.074–1.248; after adjustment: OR = 1.145, 95% CI: 1.068–1.222, p < 0.05; CDT: OR = 1.524, 95% CI: 1.303–1.745; after adjustment: OR = 1.518, 95% CI: 1.294–1.742, p < 0.001). The BNT and TMT scores after adjustment were not significantly different from those before adjustment (BNT: before adjustment: OR = 1.048, 95% CI: 0.877–1.219; after adjustment: OR = 1.026, 95% CI: 0.863–1.189, p > 0.05; TMT: before adjustment: OR = 0.816, 95% CI: 1.122–1.490; after adjustment: OR = 0.791, 95% CI: 0.406–1.176, p > 0.05).ConclusionHigh-frequency rTMS can effectively improve cognitive impairment, especially memory and visuospatial ability, in WD patients. The incidence of side effects is low, and the safety is good.

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“…At present, there are many studies on the clinical application of rTMS in the treatment of post-stroke dementia, and gratifying results have been achieved ( 17 , 18 ). Cha et al ( 19 ) performed high-frequency transcranial magnetic therapy in patients with PSCI and assessed cognitive and emotional abilities at 2 and 14 weeks of treatment.…”

Section: Introductionmentioning

confidence: 99%

Effect of high-frequency (5Hz) rTMS stimulating left DLPFC combined with galantamine on cognitive impairment after ischemic stroke and serum homocysteine and neuron-specific enolase

Hu,

Zhang,

Sun

et al. 2024

Front. Neurol.

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ObjectiveTo investigate the efficacy of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) combined with galantamine in patients with cognitive impairment after stroke and its effect on serum homocysteine (Hcy) and neuron-specific enolase (NSE) levels.MethodsA total of 90 patients with cognitive impairment after the first ischemic stroke were enrolled. They were randomly divided into rTMS+ cognitive rehabilitation group, Galantamine + cognitive rehabilitation group, and rTMS+ Galantamine + cognitive rehabilitation group. All groups received routine medical treatment and limb rehabilitation treatment. The rTMS stimulation site was the left dorsolateral prefrontal cortex (left DLPFC), the magnetic stimulation frequency was 5 Hz, the magnetic stimulation intensity was 80% of the motor threshold level, and 3,000 pulses were given every day. The Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Fugl-Meyer scale, and modified Barthel index, as well as rehabilitation scale and serum NSE and Hcy were evaluated before and after treatment (after 4 weeks).ResultsAfter 4 weeks of treatment, the scores of MMSE, MoCa scale, Fugl-Meyer scale, and modified Barthel index in the three groups were significantly higher than those before treatment (all p < 0.05), while the serum NSE and Hcy levels of the three groups were decreased. rTMS+ Galantamine + cognitive rehabilitation group had higher scale scores, and the difference between the three groups was statistically significant compared with the other two groups (all p < 0.05).ConclusionCognitive rehabilitation combined with HF-rTMS and galantamine could improve the cognitive function of patients to the greatest extent, promote the recovery of physical activity, improve the self-care ability of daily life, and effectively reduce the serum HCY and NSE levels in patients with cognitive impairment after stroke. No randomized controlled trials of similar combination treatments have been reported. The better therapeutic effect may be related to the fact that galantamine combined with repetitive transcranial magnetism can activate the brain cholinergic system more extensively, promote brain neural remodeling through long-term potentiation and inhibit local neuroinflammatory responses in brain injury.

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Repetitive transcranial magnetic stimulation combined with cognitive training for cognitive function and activities of daily living in patients with post-stroke cognitive impairment: A systematic review and meta-analysis

Cited by 16 publications

References 55 publications

Efficacy of repetitive transcranial magnetic stimulation in post-stroke cognitive impairment: an overview of systematic reviews

Efficacy of repetitive transcranial magnetic stimulation in post-stroke cognitive impairment: an overview of systematic reviews

Effect of high-frequency repetitive transcranial magnetic stimulation on cognitive impairment in WD patients based on inverse probability weighting of propensity scores

Effect of high-frequency (5Hz) rTMS stimulating left DLPFC combined with galantamine on cognitive impairment after ischemic stroke and serum homocysteine and neuron-specific enolase

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