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rTMS 对帕金森病认知功能的影响:系统评价和荟萃分析。

Effect of rTMS on Parkinson's cognitive function: a systematic review and meta-analysis.

机构信息

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.

出版信息

BMC Neurol. 2020 Oct 19;20(1):377. doi: 10.1186/s12883-020-01953-4.


DOI:10.1186/s12883-020-01953-4
PMID:33076870
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7574251/
Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3627/7574251/7138f16f6d2e/12883_2020_1953_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3627/7574251/b2f5f98d0480/12883_2020_1953_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3627/7574251/6c6f9477251d/12883_2020_1953_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3627/7574251/90977327a3b8/12883_2020_1953_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3627/7574251/178e683ef1f6/12883_2020_1953_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3627/7574251/ee6a702ecbbe/12883_2020_1953_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3627/7574251/7138f16f6d2e/12883_2020_1953_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3627/7574251/b2f5f98d0480/12883_2020_1953_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3627/7574251/6c6f9477251d/12883_2020_1953_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3627/7574251/90977327a3b8/12883_2020_1953_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3627/7574251/178e683ef1f6/12883_2020_1953_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3627/7574251/ee6a702ecbbe/12883_2020_1953_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3627/7574251/7138f16f6d2e/12883_2020_1953_Fig6_HTML.jpg

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Mov Disord. 2025-8

[2]
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[3]
The Effect of Repetitive Transcranial Magnetic Stimulation Treatment on Plasma BDNF Concentration and Executive Functions in Parkinson's Disease: A Theoretical Translational Medicine Approach.

Int J Mol Sci. 2025-1-30

[4]
Efficacy of brain stimulation therapies across psychiatric, movement, and cognitive disorders: an umbrella review synthesizing meta-analyses of randomized controlled trials.

EClinicalMedicine. 2025-1-7

[5]
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Front Aging Neurosci. 2024-10-16

[6]
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[7]
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[8]
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[9]
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[10]
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本文引用的文献

[1]
Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014-2018).

Clin Neurophysiol. 2020-1-1

[2]
Repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex to alleviate depression and cognitive impairment associated with Parkinson's disease: A review and clinical implications.

J Neurol Sci. 2018-8-15

[3]
Repetitive Deep TMS for Parkinson Disease: A 3-Month Double-Blind, Randomized Sham-Controlled Study.

J Clin Neurophysiol. 2018-3

[4]
Transcranial magnetic stimulation does not improve mild cognitive impairment in Parkinson's disease.

Mov Disord. 2018-3

[5]
Using non-invasive transcranial stimulation to improve motor and cognitive function in Parkinson's disease: a systematic review and meta-analysis.

Sci Rep. 2017-11-1

[6]
Noninvasive Brain Stimulation and Implications for Nonmotor Symptoms in Parkinson's Disease.

Int Rev Neurobiol. 2017

[7]
Cognitive Training and Noninvasive Brain Stimulation for Cognition in Parkinson's Disease: A Meta-analysis.

Neurorehabil Neural Repair. 2017-7

[8]
The role of the prefrontal cortex in freezing of gait in Parkinson's disease: insights from a deep repetitive transcranial magnetic stimulation exploratory study.

Exp Brain Res. 2017-8

[9]
Phenotype of postural instability/gait difficulty in Parkinson disease: relevance to cognitive impairment and mechanism relating pathological proteins and neurotransmitters.

Sci Rep. 2017-3-23

[10]
Deictic and Propositional Meaning-New Perspectives on Language in Schizophrenia.

Front Psychiatry. 2017-2-10

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