经颅磁刺激对脑卒中后患者认知功能的影响：系统评价和荟萃分析。

BACKGROUND AND OBJECTIVE: Transcranial magnetic stimulation (TMS) is considered as a promising treatment option for post-stroke cognitive impairment (PSCI).Some meta-analyses have indicated that TMS can be effective in treating cognitive decline in stroke patients, but the quality of the studies included and the methodologies employed were less than satisfactory. Thus, this meta-analysis aimed to evaluate the efficacy and safety of TMS for treating post-stroke cognitive impairment. METHODS: We searched online databases like PubMed, Embase, Cochrane Library, and Web of Science to retrieve randomized controlled trials (RCTs) of TMS for the treatment of patients with PSCI. Two independent reviewers identified relevant literature, extracted purpose-specific data, and the Cochrane Risk of Bias Assessment Scale was utilized to assess the potential for bias in the literature included in this study. Stata 17.0 software was used for data analysis. RESULTS: A total of 10 studies involving 414 patients were included. The results of the meta-analysis showed that TMS was significantly superior to the control group for improving the overall cognitive function of stroke patients (SMD = 1.17, 95% CI [0.59, 1.75], I = 86.1%, P < 0.001). Subgroup analyses revealed that high-frequency rTMS (HF-rTMS), low-frequency rTMS (LF-rTMS), and intermittent theta burst stimulation (iTBS) all have a beneficial effect on the overall cognitive function of stroke patients. However, another subgroup analysis failed to demonstrate any significant advantage of TMS over the control group in terms of enhancing scores on the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and Rivermead Behavioral Memory Test (RBMT) scales. Nonetheless, TMS demonstrated the potential to enhance the recovery of activities of daily living in stroke patients, as indicated by the Modified Barthel Index (MBI) (SMD = 0.76; 95% CI [0.22, 1.30], I = 52.6%, P = 0.121). CONCLUSION: This meta-analysis presents evidence supporting the safety and efficacy of TMS as a non-invasive neural modulation tool for improving global cognitive abilities and activities of daily living in stroke patients. However, given the limited number of included studies, further validation of these findings is warranted through large-scale, multi-center, double-blind, high-quality randomized controlled trials. PROSPERO REGISTRATION NUMBER: CRD42022381034.

背景与目的：经颅磁刺激（TMS）被认为是治疗卒中后认知障碍（PSCI）的一种有前途的治疗选择。一些荟萃分析表明，TMS 可有效治疗卒中患者的认知下降，但纳入研究的质量和所采用的方法并不令人满意。因此，本荟萃分析旨在评估 TMS 治疗卒中后认知障碍的疗效和安全性。

方法：我们检索了 PubMed、Embase、Cochrane 图书馆和 Web of Science 等在线数据库，以检索 TMS 治疗 PSCI 患者的随机对照试验（RCT）。两位独立的评审员确定了相关文献，提取了特定目的的数据，并使用 Cochrane 偏倚风险评估量表评估了纳入本研究文献的潜在偏倚。使用 Stata 17.0 软件进行数据分析。

结果：共有 10 项研究纳入了 414 名患者。荟萃分析结果表明，TMS 组在改善卒中患者整体认知功能方面明显优于对照组（SMD=1.17，95%CI[0.59,1.75]，I²=86.1%，P<0.001）。亚组分析显示，高频 rTMS（HF-rTMS）、低频 rTMS（LF-rTMS）和间歇性经颅磁刺激（iTBS）均对卒中患者的整体认知功能有有益的影响。然而，另一个亚组分析未能表明 TMS 组在改善洛文斯顿职业治疗认知评估（LOTCA）和Rivermead 行为记忆测试（RBMT）量表评分方面优于对照组。尽管如此，TMS 显示出改善卒中患者日常生活活动能力恢复的潜力，表现在改良巴氏指数（MBI）（SMD=0.76；95%CI[0.22,1.30]，I²=52.6%，P=0.121）。

结论：本荟萃分析提供了 TMS 作为一种非侵入性神经调节工具，用于改善卒中患者整体认知能力和日常生活活动能力的安全性和有效性的证据。然而，鉴于纳入研究的数量有限，需要通过大规模、多中心、双盲、高质量的随机对照试验进一步验证这些发现。

PROSPERO 注册号：CRD42022381034。