Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung City, Taiwan.
Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.
Alzheimers Res Ther. 2023 Jan 25;15(1):20. doi: 10.1186/s13195-023-01164-2.
BACKGROUND: Dementia [i.e., Alzheimer disease (AD)], the most common neurodegenerative disease, causes profound negative impacts on executive function and quality of life. Available pharmacological treatments often fail to achieve satisfactory outcomes. Noninvasive brain stimulation (NIBS) techniques, which focally modify cortical function and enhance synaptic long-term potentiation, are potentially beneficial for the cognition in patients with AD. The aim of the current network meta-analysis (NMA) was to evaluate the efficacy and safety of different NIBS interventions in patients with AD through NMA. METHODS: Only randomized controlled trials (RCTs) examining NIBS interventions in patients with AD had been included. All NMA procedures were performed under the frequentist model. The primary and secondary outcomes were changes in cognitive function and quality of life, respectively. RESULTS: Nineteen RCTs (639 participants) were included. The mean treatment and follow-up durations were 5.7 and 10.5 weeks, respectively. The combination of cathodal tDCS of the left dorsolateral prefrontal cortex and anodal tDCS over the right supraorbital region (c-tDCS-F3 + a-tDCS-Fp2) was associated with a significant beneficial effect on cognition compared with sham controls (standardized mean difference=2.43, 95% confidence interval=0.61-4.26, n=12 and 11). It was also associated with the greatest beneficial effect on cognition among all the investigated NIBS approaches. All the methods were well tolerated with regard to the safety profile, as reflected in the rates of adverse events or local discomfort, as well as acceptability, as indicated by dropout rate. CONCLUSIONS: The present findings provide evidence of the benefits of NIBS, especially tDCS, for beneficial effect on cognition in patients with AD. However, because of few studies included, this effect was not replicated yet in the other studies. Therefore, future larger-scale and longer follow-up duration RCTs should be warranted. TRIAL REGISTRATION: PROSPERO CRD42020209516. The current study had been approved by the Institutional Review Board of the Tri-Service General Hospital, National Defense Medical Center (TSGHIRB No. B-109-29).
背景：痴呆症（即阿尔茨海默病，AD）是最常见的神经退行性疾病，对执行功能和生活质量造成严重负面影响。现有的药物治疗往往无法取得满意的效果。非侵入性脑刺激（NIBS）技术可以有针对性地改变皮质功能并增强突触长时程增强，对于 AD 患者的认知功能具有潜在益处。本网络荟萃分析（NMA）旨在通过 NMA 评估不同 NIBS 干预措施对 AD 患者的疗效和安全性。
方法：仅纳入了评估 AD 患者 NIBS 干预措施的随机对照试验（RCT）。所有 NMA 程序均在经典频率派模型下进行。主要和次要结局分别为认知功能和生活质量的变化。
结果：共纳入 19 项 RCT（639 名参与者）。平均治疗和随访时间分别为 5.7 周和 10.5 周。左背外侧前额叶的阴极 tDCS 与右眶上区的阳极 tDCS（c-tDCS-F3 + a-tDCS-Fp2）联合治疗与假对照相比，对认知功能具有显著的有益影响（标准化均数差=2.43，95%置信区间=0.61-4.26，n=12 和 11）。在所有研究的 NIBS 方法中，该方法对认知功能的有益效果最大。所有方法在安全性方面均具有良好的耐受性，这反映在不良事件或局部不适的发生率以及可接受性（表明退出率）上。
结论：本研究结果提供了 NIBS（特别是 tDCS）对 AD 患者认知功能有益影响的证据。然而，由于纳入的研究较少，这一效果尚未在其他研究中得到复制。因此，未来需要进行更大规模和更长随访时间的 RCT 来验证这一效果。
试验注册：PROSPERO CRD42020209516。本研究已获得三军总医院国防医学中心机构审查委员会（TSGHIRB No. B-109-29）的批准。
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