经颅磁刺激对轻度认知障碍和阿尔茨海默病认知功能增强的影响：一项系统评价和荟萃分析。
Transcranial magnetic stimulation effects on cognitive enhancement in mild cognitive impairment and Alzheimer's disease: a systematic review and meta-analysis.
作者信息
Yan Yixin, Tian Minjie, Wang Tong, Wang Xixi, Wang Yingying, Shi Jingping
机构信息
Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.
出版信息
Front Neurol. 2023 Jul 17;14:1209205. doi: 10.3389/fneur.2023.1209205. eCollection 2023.
INTRODUCTION
Transcranial magnetic stimulation (TMS) is a non-invasive intervention that holds promise for improving cognitive function in individuals with Alzheimer's disease (AD). However, the effectiveness of this therapy and the optimal TMS parameters has not reached a consensus. The purpose of the meta-analysis was to systematically discern the effectiveness of different components of TMS protocols on cognitive improvement in patients with mild cognitive impairment (MCI) and AD.
METHODS
The meta-analysis was preregistered on Prospero (registration number: CRD42022345482). PubMed, Web of Science, Science Direct, and Cochrane Library databases were used to search, screen and identify eligible studies with the following keywords: Transcranial Magnetic Stimulation OR TMS OR theta burst stimulation AND Alzheimer OR Alzheimers OR Alzheimer's OR mild cognitive impairment OR MCI. Randomized controlled trials (RCTs) of participants with accepted standardized diagnostic criteria were searched by two authors independently. The risk of bias was assessed using an adapted Cochrane Risk of Bias tool. Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated using the random-effects models. Subgroup analyses were performed to investigate the influential factors.
RESULTS
A total of 21 studies and 25 trials were included in this meta-analysis. The findings revealed a significant overall cognition improvement of real stimulation compared with sham stimulation (short-term effects: SMD, 0.91; 95% CI 0.44-1.38; < 0.01; long-lasting effects: SMD, 0.91; 95% CI 0.27-1.55; < 0.01). Subgroup analysis demonstrated that stimulation of the left dorsolateral prefrontal cortex and bilateral cerebellums, as well as moderate frequency stimulation (5 Hz and 10 Hz) on mild and moderate cognitive impairment patients, were more effective than other TMS protocols. However, the additional application of cognitive training showed no significant improvement.
CONCLUSION
Cognitive improvement effect of TMS was demonstrated in MCI and AD patients in both short-term assessment and long-lasting outcomes, and the efficiency of TMS is affected by the stimulation frequency, stimulation site, and participant characteristics. Further RCTs are needed to validate the findings of our subgroup analysis.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022345482, identifier: CRD42022345482.
引言
经颅磁刺激（TMS）是一种非侵入性干预措施，有望改善阿尔茨海默病（AD）患者的认知功能。然而，这种疗法的有效性以及最佳TMS参数尚未达成共识。本荟萃分析的目的是系统地识别TMS方案不同组成部分对轻度认知障碍（MCI）和AD患者认知改善的有效性。
方法
该荟萃分析已在国际前瞻性系统评价注册库（Prospero）上预先注册（注册号：CRD42022345482）。使用PubMed、科学网、Science Direct和Cochrane图书馆数据库，通过以下关键词搜索、筛选和识别符合条件的研究：经颅磁刺激或TMS或theta波爆发刺激以及阿尔茨海默病或阿尔茨海默氏症或阿尔茨海默病或轻度认知障碍或MCI。由两位作者独立搜索符合标准化诊断标准参与者的随机对照试验（RCT）。使用改良的Cochrane偏倚风险工具评估偏倚风险。使用随机效应模型计算标准化平均差（SMD）和95%置信区间（CI）。进行亚组分析以研究影响因素。
结果
本荟萃分析共纳入21项研究和25项试验。结果显示，与假刺激相比，真实刺激在总体认知方面有显著改善（短期效应：SMD，0.91；95%CI 0.44 - 1.38；P < 0.01；长期效应：SMD，0.91；95%CI 0.27 - 1.55；P < 0.01）。亚组分析表明，刺激左侧背外侧前额叶皮层和双侧小脑，以及对轻度和中度认知障碍患者进行中等频率刺激（5Hz和10Hz），比其他TMS方案更有效。然而，额外应用认知训练并未显示出显著改善。
结论
在短期评估和长期结果中，TMS对MCI和AD患者均显示出认知改善效果，且TMS的疗效受刺激频率、刺激部位和参与者特征的影响。需要进一步的RCT来验证我们亚组分析的结果。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022345482，标识符：CRD42022345482。
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