非侵入性脑刺激在帕金森病患者的双重任务中增强运动和认知表现：系统评价和荟萃分析。
Non-invasive brain stimulation enhances motor and cognitive performances during dual tasks in patients with Parkinson's disease: a systematic review and meta-analysis.
机构信息
Department of Human Movement Science, Incheon National University, Incheon, South Korea.
Division of Sport Science, Sport Science Institute & Health Promotion Center, Incheon National University, Incheon, South Korea.
出版信息
J Neuroeng Rehabil. 2024 Nov 25;21(1):205. doi: 10.1186/s12984-024-01505-8.
BACKGROUND
Parkinson's disease (PD) induces progressive deficits in motor and cognitive functions as well as impaired dual-task performance requiring both motor and cognitive functions. This systematic review and meta-analysis evaluated the effects of non-invasive brain stimulation (NIBS) on dual-task performance in patients with PD.
METHODS
11 studies met the following inclusion criteria: (a) patients with PD, (b) NIBS intervention, (c) comparison with the sham stimulation group, (d) motor and cognitive performance outcomes during dual tasks, and (e) randomized controlled trials with parallel or crossover designs. Individual effect size (i.e., comparison) was quantified by comparing motor and cognitive performances changes during dual tasks between active NIBS and sham stimulation conditions. Thus, higher values of the overall effect size indicate more improvements in either motor or cognitive performances after NIBS. Moreover, moderator variable analyses determined whether NIBS effects on dual-task performances differed depending on targeted brain regions. Finally, meta-regression analyses determined whether NIBS effects on dual-task performances were associated with demographic characteristics.
RESULTS
The random-effects model meta-analysis revealed that NIBS significantly improved motor (73 comparisons from 11 studies) and cognitive (12 comparisons from four studies) performances during dual tasks in patients with PD. Specifically, anodal transcranial direct current stimulation protocols on the dorsolateral prefrontal cortex were effective. Moreover, greater improvements in motor performance during dual tasks significantly correlated with decreased age and increased proportion of females, respectively.
CONCLUSION
This meta-analysis suggests that excitatory stimulation on the dorsolateral prefrontal cortex may be effective for improving dual-task performance in patients with PD.
背景
帕金森病（PD）可导致运动和认知功能逐渐下降，以及需要运动和认知功能的双重任务表现受损。本系统评价和荟萃分析评估了非侵入性脑刺激（NIBS）对 PD 患者双重任务表现的影响。
方法
符合以下纳入标准的 11 项研究：（a）PD 患者，（b）NIBS 干预，（c）与假刺激组比较，（d）双重任务中的运动和认知表现结果，以及（e）具有平行或交叉设计的随机对照试验。个体效应大小（即比较）通过比较主动 NIBS 和假刺激条件下双重任务期间的运动和认知表现变化来量化。因此，总体效应大小的值越高，表示在 NIBS 后运动或认知表现的改善程度越高。此外，进行了调节变量分析，以确定 NIBS 对双重任务表现的影响是否取决于目标脑区。最后，进行了荟萃回归分析，以确定 NIBS 对双重任务表现的影响是否与人口统计学特征有关。
结果
随机效应模型荟萃分析显示，NIBS 可显著改善 PD 患者双重任务中的运动（11 项研究中的 73 项比较）和认知（4 项研究中的 12 项比较）表现。具体而言，背外侧前额叶的阳极经颅直流电刺激方案有效。此外，双重任务中运动表现的改善与年龄的降低和女性比例的增加呈显著正相关。
结论
本荟萃分析表明，背外侧前额叶的兴奋性刺激可能对改善 PD 患者的双重任务表现有效。
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