Department of Radiology and Institute of Rehabilitation and Imaging of Brain Function, The Second Clinical Medical College of North Sichuan Medical College Nanchong Central Hospital, NO. 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China.
Department of Radiology, Peking University Third Hospital, Beijing, China.
BMC Neurol. 2020 Oct 19;20(1):377. doi: 10.1186/s12883-020-01953-4.
BACKGROUND: To evaluate the effects and optimal parameters of repetitive transcranial magnetic stimulation (rTMS) on cognition function of patients with Parkinson's disease (PD) and to estimate which cognitive function may obtain more benefits from rTMS. METHOD: The articles dealing with rTMS on cognitive function of PD patients were retrieved from the databases until April 2019. Outcomes of global cognitive function and different cognitive domains were extracted. The standardized mean differences (SMDs) with 95% confidence interval (CI) of cognitive outcome for different parameters, scales, and cognitive functions were estimated. RESULTS: Fourteen studies involving 173 subjects were included in this meta-analysis. A significant effect size was observed with the mini-mental state examination (MMSE) for the global cognitive outcome based on the evidence of four published articles. Further subtests for different cognitive domains demonstrated prominent effect for the executive function. The significant effect sizes for executive function were found with multiple sessions of high-frequency rTMS over frontal cortex; especially over dorsolateral prefrontal cortex (DLPFC). All of the other cognitive domains, which included memory, attention, and language ability, did not obtain significant effects. CONCLUSIONS: Multiple sessions of high-frequency rTMS over the DLPFC may have positive effect on executive function in PD patients. Further well designed studies with large sample sizes are needed to verify our results and ascertain the long-term effects of rTMS.
背景:评估重复经颅磁刺激(rTMS)对帕金森病(PD)患者认知功能的影响及最佳参数,并评估哪种认知功能可能从 rTMS 中获得更多益处。
方法:检索截至 2019 年 4 月数据库中关于 rTMS 对 PD 患者认知功能影响的文章。提取整体认知功能和不同认知领域的结果。使用标准化均数差值(SMD)和 95%置信区间(CI)评估不同参数、量表和认知功能的认知结果。
结果:本荟萃分析纳入了 14 项研究共 173 名受试者。四项已发表文章的证据表明,基于简易精神状态检查(MMSE)的整体认知结果存在显著的效应量。不同认知领域的进一步亚测试显示执行功能有明显的效果。额叶高频 rTMS 多次治疗显示出对执行功能的显著影响;尤其是背外侧前额叶(DLPFC)。所有其他认知领域,包括记忆、注意力和语言能力,均未获得显著效果。
结论:DLPFC 多次高频 rTMS 可能对 PD 患者的执行功能有积极影响。需要进一步进行设计良好、样本量大的研究来验证我们的结果,并确定 rTMS 的长期效果。
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