Department of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.
Department of Rehabilitation, Dongguan Songshan Lake Tungwah Hospital, DongGuan, China.
Ageing Res Rev. 2024 Nov;101:102508. doi: 10.1016/j.arr.2024.102508. Epub 2024 Sep 19.
Mild cognitive impairment (MCI) is a critical time window for implementing prevention strategies to attenuate or delay cognitive decline. Non-invasive brain stimulation (NIBS) techniques are promising non-pharmacological therapies for improving the cognitive function of MCI, but it is unclear which type of NIBS protocol is most effective. This study aimed to compare and rank the beneficial effect of different NIBS methods/protocols on cognitive function and examine the acceptability of NIBS in patients with MCI.
Electronic search of PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure, Wanfang Database, and Chongqing VIP Database up to November 2023. Patients with diagnosis of MCI were included. The primary outcomes were acceptability and pre-post treatment changes in global cognitive function, and the secondary outcomes were specific cognitive domains (language and executive function). All network meta‑analysis procedures were performed under the frequentist model. A protocol for this systematic review was registered in PROSPERO (Registration number: CRD42023441448).
A network meta-analysis was conducted on 19 eligible RCTs consisting of 599 subjects. Compared with the sham stimulation, Repetitive Transcranial Magnetic Stimulation over the Bilateral dorsolateral prefrontal cortex (rTMS-F3F4) showed the strongest improvement in global cognitive function in MCI patients (SMD =1.52[95 %CIs =0.49-2.56]), followed by rTMS over the left dorsolateral prefrontal cortex (rTMS-F3) (SMD =1.25[95 %CIs =0.57-1.93]); Moreover, rTMS-F3F4 showed more significant efficacy in language function (SMD =0.96[95 %CIs = 0.20-1.72]); No statistically significant differences were found among the other cognitive domains. Compared with the rTMS-F4, rTMS-F3F4 showed a stronger improvement in global cognitive function in MCI patients (SMD =1.80[95 %CIs =0.02-3.59]). Similar results were obtained in subgroup analyses of cognitive function. All the methods were well-tolerated with an acceptable safety profile.
The present findings provide evidence of the benefits of NIBS, especially TMS stimulating the bilateral dorsolateral prefrontal cortex, for the beneficial effect on cognitive and language function in patients with MCI. However, because few studies were available for inclusion, additional well-designed, large-scale RCTs are warranted to support exploring longer-term dynamic effects.
轻度认知障碍（MCI）是实施预防策略以减轻或延缓认知能力下降的关键窗口期。非侵入性脑刺激（NIBS）技术是改善 MCI 认知功能的有前途的非药物治疗方法，但哪种类型的 NIBS 方案最有效尚不清楚。本研究旨在比较和排名不同 NIBS 方法/方案对认知功能的有益影响，并检查 NIBS 在 MCI 患者中的可接受性。
电子检索 PubMed、Cochrane 图书馆、EMBASE、中国知识基础设施、万方数据库和重庆 VIP 数据库，检索时间截至 2023 年 11 月。纳入 MCI 诊断患者。主要结局是可接受性和全球认知功能治疗前后的变化，次要结局是特定认知领域（语言和执行功能）。所有网络荟萃分析程序均在似然主义模型下进行。本系统评价的方案已在 PROSPERO（注册号：CRD42023441448）中注册。
对 19 项符合条件的 RCT 进行了网络荟萃分析，共纳入 599 名受试者。与假刺激相比，双侧背外侧前额叶皮质重复经颅磁刺激（rTMS-F3F4）在 MCI 患者中的整体认知功能改善最为明显（SMD=1.52[95%CI=0.49-2.56]），其次是左侧背外侧前额叶皮质 rTMS（rTMS-F3）（SMD=1.25[95%CI=0.57-1.93]）；此外，rTMS-F3F4 在语言功能方面显示出更显著的疗效（SMD=0.96[95%CI=0.20-1.72]）；其他认知领域之间无统计学差异。与 rTMS-F4 相比，rTMS-F3F4 在 MCI 患者的整体认知功能方面显示出更强的改善（SMD=1.80[95%CI=0.02-3.59]）。在认知功能的亚组分析中也得到了类似的结果。所有方法均耐受良好，安全性可接受。
本研究结果为 NIBS，特别是刺激双侧背外侧前额叶皮质的 TMS，对 MCI 患者的认知和语言功能有益影响提供了证据。然而，由于纳入的研究较少，需要更多设计良好、规模较大的 RCT 来支持探索更长期的动态效应。
