重复经颅磁刺激联合认知训练对脑卒中后认知障碍患者认知功能和日常生活活动能力的影响：系统评价和 Meta 分析。
Repetitive transcranial magnetic stimulation combined with cognitive training for cognitive function and activities of daily living in patients with post-stroke cognitive impairment: A systematic review and meta-analysis.
机构信息
Department of Rehabilitation, Shaoxing People's Hospital, Shaoxing, China; Department of Rehabilitation, Jiangsu Province People's Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China.
Department of Rehabilitation, Jiangsu Province People's Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China.
出版信息
Ageing Res Rev. 2023 Jun;87:101919. doi: 10.1016/j.arr.2023.101919. Epub 2023 Mar 31.
BACKGROUND
Despite the potential effect of repetitive transcranial magnetic stimulation (rTMS) combined with cognitive training for post-stroke cognitive impairment (PSCI), there is uncertainty regarding rTMS combined with cognitive training for PSCI.
OBJECTIVE
To determine the effectiveness of rTMS combined with cognitive training for improving global cognitive function, specific domains of cognitive function and activities of daily living (ADL) in patients with PSCI.
METHODS
Databases including Cochrane Central, EMBASE (Ovid SP), CHINAL, APA PsycINFO, EBSCO, Medline, Web of science and other sources were systematically searched on March 23, 2022, and updated on December 5, 2022. All randomized controlled trials (RCTs) applied rTMS + cognitive training for patients with PSCI were screened for inclusion.
RESULTS
A total of 8 trials was finally included and 336 participants provided data for meta-analyses. Large effects were found for rTMS + cognitive training on global cognition (g = 0.780, 95 % CI = 0.477-1.083), executive function (g = 0.769, 95 % CI = 0.291-1.247), working memory (g = 0.609, 95 % CI = 0.158-1.061) and medium improvement on ADL (g = 0.418, 95 % CI = 0.058-0.778) were seen. While, no effects were found on memory or attention. Subgroup analyses showed that combinations of phase of stroke onset, rTMS frequency, stimulation site and stimulation sessions were potent factors that modulate the effects of rTMS + cognitive training for cognitive function.
CONCLUSIONS
The pooled data showed more positive effects of rTMS + cognitive training for global cognition, executive function, working memory and ADL in patients with PSCI. While, robust evidence of rTMS + cognitive training for global cognition, executive function, working memory and ADL from the Grade recommendations is lacking. Further, rTMS + cognitive training did not show no better effects on memory. Future definitive trials are needed to determine the benefits of rTMS + cognitive training for cognitive function and ADL in the field of PSCI.
背景
尽管重复经颅磁刺激（rTMS）联合认知训练对卒中后认知障碍（PSCI）可能有效，但 rTMS 联合认知训练对 PSCI 的效果尚不确定。
目的
评估 rTMS 联合认知训练对改善 PSCI 患者整体认知功能、特定认知领域功能和日常生活活动能力（ADL）的效果。
方法
系统检索 Cochrane 中央、EMBASE（Ovid SP）、中国生物医学文献数据库、APA PsycINFO、EBSCO、Medline、Web of science 和其他来源数据库，检索时间截至 2022 年 3 月 23 日，并于 2022 年 12 月 5 日进行更新。筛选纳入所有应用 rTMS+认知训练治疗 PSCI 患者的随机对照试验（RCT）。
结果
最终纳入 8 项研究，336 名患者的数据可进行荟萃分析。rTMS+认知训练对整体认知（g=0.780，95%CI=0.477-1.083）、执行功能（g=0.769，95%CI=0.291-1.247）、工作记忆（g=0.609，95%CI=0.158-1.061）的疗效为大效应，ADL（g=0.418，95%CI=0.058-0.778）的疗效为中效应。但对记忆或注意力无影响。亚组分析显示，卒中发病阶段、rTMS 频率、刺激部位和刺激疗程的组合是调节 rTMS+认知训练对认知功能影响的重要因素。
结论
汇总数据表明，rTMS+认知训练对 PSCI 患者整体认知、执行功能、工作记忆和 ADL 的效果更优。但现有证据尚不足以支持 rTMS+认知训练可改善整体认知、执行功能、工作记忆和 ADL 的推荐等级。此外，rTMS+认知训练对记忆并无更好效果。未来还需要进行更确定的试验来确定 rTMS+认知训练对 PSCI 患者认知功能和 ADL 的获益。
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