Sharbafshaaer Minoo, Gigi Ilaria, Lavorgna Luigi, Esposito Sabrina, Bonavita Simona, Tedeschi Gioacchino, Esposito Fabrizio, Trojsi Francesca
MRI Research Center, Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", 80138 Naples, Italy.
First Division of Neurology, Università degli Studi della Campania "Luigi Vanvitelli", 80138 Naples, Italy.
J Clin Med. 2023 Sep 25;12(19):6190. doi: 10.3390/jcm12196190.
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique also used as a non-pharmacological intervention against cognitive impairment. The purpose of the present review was to summarize what is currently known about the effectiveness of rTMS intervention on different cognitive domains in patients with mild cognitive impairment (MCI) and to address potential neuromodulation approaches in combination with electroencephalography (EEG) and neuroimaging, especially functional magnetic resonance imaging (fMRI). In this systematic review, we consulted three main databases (PubMed, Science Direct, and Scopus), and Google Scholar was selected for the gray literature search. The PRISMA flowchart drove the studies' inclusion. The selection process ensured that only high-quality studies were included; after removing duplicate papers, explicit ratings were given based on the quality classification as high (A), moderate (B), or low (C), considering factors such as risks of bias, inaccuracies, inconsistencies, lack of direction, and publication bias. Seven full-text articles fulfilled the stated inclusion, reporting five double-blind, randomized, sham-controlled studies, a case study, and a randomized crossover trial. The results of the reviewed studies suggested that rTMS in MCI patients is safe and effective for enhancing cognitive functions, thus making it a potential therapeutic approach for MCI patients. Changes in functional connectivity within the default mode network (DMN) after targeted rTMS could represent a valuable indicator of treatment response. Finally, high-frequency rTMS over the dorsolateral prefrontal cortex (DLPFC) has been shown to significantly enhance cognitive functions, such as executive performance, together with the increase of functional connectivity within frontoparietal networks. The main limitations were the number of included studies and the exclusion of studies using intermittent theta-burst stimulation, used in studies on Alzheimer's disease. Therefore, neuroimaging techniques in combination with rTMS have been shown to be useful for future network-based, fMRI-guided therapeutic approaches.
重复经颅磁刺激（rTMS）是一种非侵入性脑刺激技术，也用作针对认知障碍的非药物干预手段。本综述的目的是总结目前已知的rTMS干预对轻度认知障碍（MCI）患者不同认知领域有效性的相关情况，并探讨结合脑电图（EEG）和神经影像学，尤其是功能磁共振成像（fMRI）的潜在神经调节方法。在本系统综述中，我们查阅了三个主要数据库（PubMed、Science Direct和Scopus），并选择谷歌学术进行灰色文献检索。PRISMA流程图指导了研究的纳入。选择过程确保只纳入高质量研究；在去除重复论文后，根据质量分类（高（A）、中（B）或低（C））给出明确评分，考虑因素包括偏倚风险、不准确、不一致、缺乏方向性和发表偏倚等。七篇全文文章符合既定纳入标准，报告了五项双盲、随机、假对照研究、一项病例研究和一项随机交叉试验。综述研究结果表明，rTMS对MCI患者增强认知功能是安全有效的，因此使其成为MCI患者的一种潜在治疗方法。靶向rTMS后默认模式网络（DMN）内功能连接的变化可能代表治疗反应的一个有价值指标。最后，已证明背外侧前额叶皮层（DLPFC）上的高频rTMS可显著增强认知功能，如执行能力，同时增加额顶叶网络内的功能连接。主要局限性在于纳入研究的数量以及排除了在阿尔茨海默病研究中使用的间歇性theta爆发刺激的研究。因此，神经影像学技术与rTMS相结合已被证明对未来基于网络、fMRI引导的治疗方法有用。
