School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
School of Nursing, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai 201203, China.
Behav Brain Res. 2023 Feb 15;439:114229. doi: 10.1016/j.bbr.2022.114229. Epub 2022 Nov 25.
Post-stroke cognitive impairment (PSCI) is one of the common symptoms in stroke survivors, by which their quality of life and rehabilitation progress are severely limited. Repetitive transcranial magnetic stimulation (rTMS) has been proven to regulate cognition in a non-invasive way. However, the inconsistency in its effectiveness on PSCI reported in previous studies cannot be ruled out. A critical and comprehensive systematic review of rTMS on PSCI patients is necessary.
Trials published before the end of February 2022 on rTMS and PSCI were systematically retrieved from PubMed, Cochrane Library, EBSCO, Embase and SCOPUS. High-quality literature was selected following the inclusion and exclusion criteria, with their references being screened. Meta-analysis of data was carried out using RevMan 5.4 software.
Ten trials involving 347 participants were included in the current review. Global cognition as measured by MMSE or MoCA (SMD=0.54; 95% CI=0.31, 0.76; P < 0.00001; I = 38%) and modified Barthel index (MD=9.00; 95% CI=2.93, 15.06; P = 0.004; I = 0%) were significantly improved by rTMS compared to sham stimulation in PSCI patients. Performance of the digit symbol test, rivermead behavioral memory test and attention in PSCI patients were also significantly improved. Subgroup analyses showed that significant differences were found in both MoCA and MMSE among PSCI patients by rTMS. MoCA was significantly improved by high frequency rTMS, while both MoCA and MMSE were significantly improved targeting on left dorsolateral prefrontal cortex.
rTMS provides a non-invasive and effective technique for the treatment of post-stroke patients with cognitive impairment.
卒中后认知障碍（PSCI）是卒中幸存者的常见症状之一，严重限制了他们的生活质量和康复进程。重复经颅磁刺激（rTMS）已被证明可以非侵入性地调节认知。然而，以前的研究报告中 rTMS 对 PSCI 的有效性存在不一致性，因此有必要对 rTMS 治疗 PSCI 患者进行系统的评价。
系统检索了 2022 年 2 月底前在 PubMed、Cochrane 图书馆、EBSCO、Embase 和 SCOPUS 上发表的关于 rTMS 和 PSCI 的试验。根据纳入和排除标准选择高质量文献，并筛选其参考文献。使用 RevMan 5.4 软件对数据进行荟萃分析。
本综述纳入了 10 项涉及 347 名参与者的试验。与假刺激相比，rTMS 可显著改善 PSCI 患者的整体认知（MMSE 或 MoCA 评分：SMD=0.54；95%CI=0.31, 0.76；P<0.00001；I=38%）和改良巴氏指数（MD=9.00；95%CI=2.93, 15.06；P=0.004；I=0%）。rTMS 还可显著改善 PSCI 患者的数字符号测试、Rivermead 行为记忆测试和注意力。亚组分析显示，rTMS 对 PSCI 患者的 MoCA 和 MMSE 均有显著改善。高频 rTMS 可显著改善 MoCA 评分，而针对左背外侧前额叶皮质的 rTMS 则可显著改善 MoCA 和 MMSE 评分。
rTMS 为卒中后认知障碍患者的治疗提供了一种非侵入性、有效的技术。
