Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2023 Feb;8(2):151-161. doi: 10.1016/j.bpsc.2022.09.014. Epub 2022 Oct 13.
Treatments for cognitive dysfunction in neuropsychiatric conditions are urgently needed. Cognitive training and transcranial direct current stimulation (tDCS) hold promise, and there is growing interest in combined or multimodal treatments, though studies to date have had small samples and inconsistent results.
A systematic review and meta-analysis was completed. Retained studies included cognitive training combined with active or sham tDCS in a neuropsychiatric population and reported a posttreatment cognitive outcome. Meta-analyses included effect sizes comparing cognitive training plus active tDCS and cognitive training plus sham tDCS in 5 cognitive domains. Risk of bias in included studies and across studies was explored.
Fifteen studies were included: 10 in neurodegenerative disorders and 5 in psychiatric disorders (n = 629). There were several tDCS montages, though two-thirds of studies placed the anode over the left dorsolateral prefrontal cortex. A wide variety of cognitive training types and outcome measures were reported. There was a small, statistically significant effect of combined treatment on measures of attention/working memory, as well as small and non-statistically significant effects favoring combined treatment on global cognition and language. There was no evidence of bias in individual studies but some evidence of nonreporting or small-study bias across studies.
These results may provide preliminary support for the efficacy of combined cognitive training and tDCS on measures of attention/working memory. More data are needed, particularly via studies that explicitly align the cognitive ability of interest, stimulation target, training type, and outcome measures.
神经精神疾病认知功能障碍的治疗方法亟待研究。认知训练和经颅直流电刺激（tDCS）具有一定的应用前景，联合或多模式治疗方法也越来越受到关注，尽管迄今为止的研究样本较小且结果不一致。
进行了系统评价和荟萃分析。保留的研究包括神经精神疾病患者的认知训练联合真 tDCS 或假 tDCS 治疗，并报告了治疗后的认知结果。荟萃分析包括比较认知训练加真 tDCS 和认知训练加假 tDCS 在 5 个认知领域的效应量。评估了纳入研究和跨研究的偏倚风险。
共纳入 15 项研究：10 项为神经退行性疾病，5 项为精神疾病（n = 629）。虽然有多种 tDCS 刺激模式，但三分之二的研究将阳极放置在左背外侧前额叶皮层。报告了各种各样的认知训练类型和结果测量方法。联合治疗对注意力/工作记忆的测量有较小但有统计学意义的影响，对整体认知和语言也有较小且无统计学意义的效果。个别研究没有偏倚的证据，但跨研究存在不报告或小样本偏倚的证据。
这些结果可能为联合认知训练和 tDCS 对注意力/工作记忆测量的疗效提供初步支持。需要更多的数据，特别是通过明确与感兴趣的认知能力、刺激目标、训练类型和结果测量相匹配的研究。
