Jiang Lijuan, Cui Huiru, Zhang Caidi, Cao Xinyi, Gu Nannan, Zhu Yikang, Wang Jijun, Yang Zhi, Li Chunbo
Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China.
Front Aging Neurosci. 2021 Jan 14;12:593000. doi: 10.3389/fnagi.2020.593000. eCollection 2020.
Mild cognitive impairment (MCI) is an early stage of Alzheimer's disease. Repetitive transcranial magnetic stimulation (rTMS) has been widely employed in MCI research. However, there is no reliable systematic evidence regarding the effects of rTMS on MCI. The aim of this review was to evaluate the efficacy and safety of rTMS in the treatment of MCI. A comprehensive literature search of nine electronic databases was performed to identify articles published in English or Chinese before June 20, 2019. The identified articles were screened, data were extracted, and the methodological quality of the included trials was assessed. The meta-analysis was performed using the RevMan 5.3 software. We used the GRADE approach to rate the quality of the evidence. Nine studies comprising 369 patients were included. The meta-analysis showed that rTMS may significantly improve global cognitive function (standardized mean difference [SMD] 2.09, 95% confidence interval [CI] 0.94 to 3.24, = 0.0004, seven studies, = 296; low-quality evidence) and memory (SMD 0.44, 95% CI 0.16 to 0.72, = 0.002, six studies, = 204; moderate-quality evidence). However, there was no significant improvement in executive function and attention ( > 0.05). Subgroup analyses revealed the following: (1) rTMS targeting the left hemisphere significantly enhanced global cognitive function, while rTMS targeting the bilateral hemispheres significantly enhanced global cognitive function and memory; (2) high-frequency rTMS significantly enhanced global cognitive function and memory; and (3) a high number of treatments ≥20 times could improve global cognitive function and memory. There was no significant difference in dropout rate ( > 0.05) between the rTMS and control groups. However, patients who received rTMS had a higher rate of mild adverse effects (risk ratio 2.03, 95% CI 1.16 to 3.52, = 0.01, seven studies, = 317; moderate-quality evidence). rTMS appears to improve global cognitive function and memory in patients with MCI and may have good acceptability and mild adverse effects. Nevertheless, these results should be interpreted cautiously due to the relatively small number of trials, particularly for low-frequency rTMS.
轻度认知障碍（MCI）是阿尔茨海默病的早期阶段。重复经颅磁刺激（rTMS）已广泛应用于MCI研究。然而，关于rTMS对MCI影响的可靠系统证据尚不存在。本综述的目的是评估rTMS治疗MCI的疗效和安全性。对九个电子数据库进行了全面的文献检索，以识别2019年6月20日前发表的英文或中文文章。对识别出的文章进行筛选，提取数据，并评估纳入试验的方法学质量。使用RevMan 5.3软件进行荟萃分析。我们采用GRADE方法对证据质量进行评级。纳入了9项研究，共369例患者。荟萃分析表明，rTMS可能显著改善整体认知功能（标准化均数差[SMD]2.09，95%置信区间[CI]0.94至3.24，P = 0.0004，7项研究，n = 296；低质量证据）和记忆力（SMD 0.44，95%CI 0.16至0.72，P = 0.002，6项研究，n = 204；中等质量证据）。然而，执行功能和注意力无显著改善（P>0.05）。亚组分析显示：（1）靶向左侧半球的rTMS显著增强整体认知功能，而靶向双侧半球的rTMS显著增强整体认知功能和记忆力；（2）高频rTMS显著增强整体认知功能和记忆力；（3）大量治疗（≥20次）可改善整体认知功能和记忆力。rTMS组与对照组的脱落率无显著差异（P>0.05）。然而，接受rTMS治疗的患者轻度不良反应发生率较高（风险比2.03，95%CI 1.16至3.52，P = 0.01，7项研究，n = 317；中等质量证据）。rTMS似乎可改善MCI患者的整体认知功能和记忆力，且可能具有良好的可接受性和轻度不良反应。然而，由于试验数量相对较少，尤其是低频rTMS，这些结果应谨慎解读。
