Liao Xiang, Li Guangming, Wang Anguo, Liu Tao, Feng Shenggang, Guo Zhiwei, Tang Qing, Jin Yu, Xing Guoqiang, McClure Morgan A, Chen Huaping, He Bin, Liu Hua, Mu Qiwen
Imaging Institute of Rehabilitation and Development of Brain Function, North Sichuan Medical University Nanchong Central Hospital, Nanchong, China.
Luzhou Medical College, Luzhou, China.
J Alzheimers Dis. 2015;48(2):463-72. doi: 10.3233/JAD-150346.
Recent studies have indicated that repetitive transcranial magnetic stimulation (rTMS) could improve cognitive function in people with Alzheimer's disease (AD). Yet the results are inconclusive.
This meta-analysis aimed to evaluate recent rTMS studies conducted in mild to moderate AD patients.
PubMed, Embase, MEDLINE databases and Science Direct were searched for studies of rTMS treatment on AD patients with cognitive impairment published before February 2015. The relevant primary outcomes of cognition were extracted from those included studies. A crude standardized mean difference (SMD) with 95% confidence interval (CI) was calculated by using random effect models.
Seven studies with a total of 94 mild to moderate AD patients were included in this meta-analysis. A significant overall rTMS treatment effect on cognition was found for all AD patients (p = 0.0008, SMD = 1.00, 95% CI = 0.41-1.58). Stratification analysis showed that this effect is stimulation frequency- and hemisphere-dependent. High frequency stimulation (>1.0 Hz) (p < 0.05) but not low frequency stimulation (≤1.0 Hz) (p > 0.05) was significantly effective in improving the cognition of AD patients. Further, rTMS stimulation on right dorsolateral prefrontal cortex (DLPFC) and bilateral DLPFC (p < 0.05), but not on the left DLPFC (p > 0.05) was significantly effective in improving cognitive function of AD patients. A significant effect was observed in the rTMS subgroup (p < 0.05), rather than in the rTMS+drug subgroup (p > 0.05).
This meta-analysis supports that high frequency rTMS stimulation on right- or bilateral-DLPFC has significant therapeutic effect on cognitive function in patients with mild to moderate AD. Due to small number of studies included, more well-controlled rTMS studies should be evaluated in AD patients in the future.
近期研究表明，重复经颅磁刺激（rTMS）可改善阿尔茨海默病（AD）患者的认知功能。然而，结果尚无定论。
本荟萃分析旨在评估近期针对轻至中度AD患者进行的rTMS研究。
检索PubMed、Embase、MEDLINE数据库及Science Direct，查找2015年2月前发表的关于rTMS治疗认知功能受损AD患者的研究。从纳入研究中提取相关认知主要结局指标。采用随机效应模型计算粗标准化均数差（SMD）及95%置信区间（CI）。
本荟萃分析纳入7项研究，共94例轻至中度AD患者。发现rTMS治疗对所有AD患者的认知有显著总体效应（p = 0.0008，SMD = 1.00，95%CI = 0.41 - 1.58）。分层分析表明，该效应与刺激频率及半球有关。高频刺激（>1.0Hz）（p < 0.05）而非低频刺激（≤1.0Hz）（p > 0.05）在改善AD患者认知方面显著有效。此外，rTMS刺激右侧背外侧前额叶皮质（DLPFC）及双侧DLPFC（p < 0.05）而非左侧DLPFC（p > 0.05）在改善AD患者认知功能方面显著有效。在rTMS亚组中观察到显著效应（p < 0.05），而在rTMS + 药物亚组中未观察到显著效应（p > 0.05）。
本荟萃分析支持高频rTMS刺激右侧或双侧DLPFC对轻至中度AD患者的认知功能有显著治疗效果。由于纳入研究数量较少，未来应在AD患者中评估更多严格对照的rTMS研究。
