重复经颅磁刺激治疗对阿尔茨海默病整体认知功能的影响：一项系统评价和荟萃分析。
Effects of rTMS treatment on global cognitive function in Alzheimer's disease: A systematic review and meta-analysis.
作者信息
Zhang Tianjiao, Sui Youxin, Lu Qian, Xu Xingjun, Zhu Yi, Dai Wenjun, Shen Ying, Wang Tong
机构信息
Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Rehabilitation Medicine, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, China.
出版信息
Front Aging Neurosci. 2022 Sep 8;14:984708. doi: 10.3389/fnagi.2022.984708. eCollection 2022.
BACKGROUND
Although repetitive transcranial magnetic stimulation (rTMS) has been extensively studied in patients with Alzheimer's disease (AD), the clinical evidence remains inconsistent. The purpose of this meta-analysis was to evaluate the effects of rTMS on global cognitive function in patients with AD.
METHODS
An integrated literature search using 4 databases (PubMed, Web of Science, Embase, and Cochrane Library) was performed to identify English language articles published up to October 6, 2021. We pooled Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog) scores using a random-effects model RevMan 5.4 software. We calculated estimates of mean differences (MD) with 95% confidence intervals (CI). The primary outcomes were pre-post treatment changes in global cognition as measured using MMSE and ADAS-Cog immediately after rTMS treatment, and the secondary outcome was duration of cognitive improvement (1-1.5 and ≥3 months).
RESULTS
Nine studies with 361 patients were included in this meta-analysis. The results showed that rTMS significantly improved global cognitive function immediately following rTMS treatment [(MD) 1.82, 95% confidence interval (CI) 1.41-2.22, < 0.00001, MMSE; 2.72, 95% CI, 1.77-3.67, < 0.00001, ADAS-Cog], and the therapeutic effects persisted for an extended duration (2.20, 95% CI, 0.93-3.47, =0.0007, MMSE; 1.96, 95% CI, 0.96-2.95, = 0.0001, ADAS-Cog). Subgroup analyses showed that high frequency rTMS targeted to the left dorsolateral prefrontal cortex (DLPFC) for over 20 sessions induced the greatest cognitive improvement, with effects lasting for more than 1 month after the final treatment. There were no significant differences in dropout rate ( > 0.05) or adverse effect rate ( > 0.05) between the rTMS and control groups.
CONCLUSIONS
Repetitive TMS is a potentially effective treatment for cognitive impairment in AD that is safe and can induce long-lasting effects. Our results also showed that ADAS-cog and MMSE differed in determination of global cognitive impairment.
SYSTEMATIC REVIEW REGISTRATION
http://www.crd.york.ac.uk/PROSPERO, PROSPERO CRD42022315545.
背景
尽管重复经颅磁刺激（rTMS）已在阿尔茨海默病（AD）患者中得到广泛研究，但其临床证据仍不一致。本荟萃分析的目的是评估rTMS对AD患者整体认知功能的影响。
方法
使用4个数据库（PubMed、Web of Science、Embase和Cochrane图书馆）进行综合文献检索，以识别截至2021年10月6日发表的英文文章。我们使用随机效应模型RevMan 5.4软件汇总简易精神状态检查表（MMSE）和阿尔茨海默病评估量表认知子量表（ADAS-Cog）得分。我们计算了平均差（MD）的估计值及95%置信区间（CI）。主要结局是rTMS治疗后立即使用MMSE和ADAS-Cog测量的整体认知治疗前后变化，次要结局是认知改善持续时间（1 - 1.5个月和≥3个月）。
结果
本荟萃分析纳入了9项研究共361例患者。结果显示，rTMS治疗后立即显著改善了整体认知功能[MD 1.82，95%置信区间（CI）1.41 - 2.22，P < 0.00001，MMSE；2.72，95% CI，1.77 - 3.67，P < 0.00001，ADAS-Cog]，且治疗效果持续较长时间（2.20，95% CI，0.93 - 3.47，P = 0.0007，MMSE；1.96，95% CI，0.96 - 2.95，P = 0.0001，ADAS-Cog）。亚组分析表明，针对左侧背外侧前额叶皮质（DLPFC）进行超过20次的高频rTMS诱导了最大的认知改善，效果在最后一次治疗后持续超过1个月。rTMS组与对照组在脱落率（P > 0.05）或不良反应率（P > 0.05）方面无显著差异。
结论
重复经颅磁刺激是一种对AD认知障碍潜在有效的治疗方法，安全且可产生持久效果。我们的结果还表明，ADAS-cog和MMSE在整体认知障碍的判定上存在差异。
系统评价注册
http://www.crd.york.ac.uk/PROSPERO，PROSPERO CRD42022315545。
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