Xie Ye, Li Yunxia, Nie Lu, Zhang Wanting, Ke Zijun, Ku Yixuan
Center for Brain and Mental Well-Being, Department of Psychology, Sun Yat-sen University, Guangzhou, China.
Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
Front Cell Dev Biol. 2021 Sep 10;9:734046. doi: 10.3389/fcell.2021.734046. eCollection 2021.
Repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation technique, has been considered as a potentially effective treatment for the cognitive impairment in patients with mild cognitive impairment (MCI) and Alzheimer's Disease (AD). However, the effectiveness of this therapy is still under debate due to the variety of rTMS parameters and individual differences including distinctive stages of AD in the previous studies. The current meta-analysis is aiming to assess the cognitive enhancement of rTMS treatment on patients of MCI and early AD. Three datasets (PubMed, Web of Science and CKNI) were searched with relative terms and finally twelve studies with 438 participants (231 in the rTMS group and 207 in the control group) in thirteen randomized, double-blind and controlled trials were included. Random effects analysis revealed that rTMS stimulation significantly introduced cognitive benefits in patients of MCI and early AD compared with the control group (mean effect size, 1.17; 95% CI, 0.76 - 1.57). Most settings of rTMS parameters (frequency, session number, stimulation site number) significantly enhanced global cognitive function, and the results revealed that protocols with 10 Hz repetition frequency and DLPFC as the stimulation site for 20 sessions can already be able to produce cognitive improvement. The cognitive enhancement of rTMS could last for one month after the end of treatment and patients with MCI were likely to benefit more from the rTMS stimulation. Our meta-analysis added important evidence to the cognitive enhancement of rTMS in patients with MCI and early AD and discussed potential underlying mechanisms about the effect induced by rTMS.
重复经颅磁刺激（rTMS）是一种非侵入性脑刺激技术，已被认为是治疗轻度认知障碍（MCI）和阿尔茨海默病（AD）患者认知障碍的一种潜在有效疗法。然而，由于先前研究中rTMS参数的多样性以及个体差异（包括AD的不同阶段），这种疗法的有效性仍存在争议。当前的荟萃分析旨在评估rTMS治疗对MCI和早期AD患者的认知增强作用。使用相关术语检索了三个数据集（PubMed、科学网和中国知网），最终纳入了13项随机、双盲和对照试验中的12项研究，共438名参与者（rTMS组231名，对照组207名）。随机效应分析显示，与对照组相比，rTMS刺激显著改善了MCI和早期AD患者的认知功能（平均效应量为1.17；95%置信区间为0.76 - 1.57）。大多数rTMS参数设置（频率、疗程数、刺激部位数量）均显著增强了整体认知功能，结果表明，重复频率为10 Hz、以背外侧前额叶皮质（DLPFC）为刺激部位、进行20个疗程的方案已经能够产生认知改善。rTMS的认知增强作用在治疗结束后可持续一个月，MCI患者可能从rTMS刺激中获益更多。我们进行的荟萃分析为rTMS对MCI和早期AD患者的认知增强作用增添了重要证据，并讨论了rTMS诱导该效应的潜在机制。
