Zhang Yu, Xu Ke, Wang Yulin, Shen Yiwei, Liu Zhengnan, Zhang Chengguang, Zhou Yan, Lv Peizhu, Bai Yan, Wang Shun
The Second Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China.
Department of Rehabilitation Medicine, Yunnan First People's Hospital, Kunming, Yunnan Province, China.
BMC Neurol. 2025 Jul 17;25(1):295. doi: 10.1186/s12883-025-04292-4.
Currently, there is a lack of reliable evidence to prove the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in the cognitive and emotional domains of neurodegenerative diseases (ND), leading to the absence of a unified and effective rTMS treatment protocol or stimulation targets. This systematic review and meta-analysis summarizes existing evidence to evaluate the efficacy of rTMS targeting the dorsolateral prefrontal cortex (DLPFC) and non-DLPFC in the cognitive and emotional aspects of ND.
For two common types of ND Alzheimer's disease (AD) and Parkinson's disease (PD), we included 17 relevant randomized controlled trials (RCTs) from five databases. Search terms included rTMS, Parkinson's disease, Alzheimer's disease, cognitive impairment, and randomized controlled studies. Two independent reviewers assessed the risk of bias in the included literature, performed data extraction, and evaluated the evidence. Treatment effects were assessed using the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), the Hamilton Depression Rating Scale (HAMD), the Hamilton Anxiety Rating Scale (HAMA), and Activities of Daily Living (ADL). Data were analyzed using R software to evaluate effect sizes and 95% confidence interval (CI). Heterogeneity tests were conducted to assess differences in treatment effects between DLPFC and non-DLPFC.
We screened 3,467 articles and identified 17 studies that met the inclusion criteria. The pooled results showed significant effects: MoCA (MD: 2.13, 95% CI [0.75, 3.52], p < 0.001); MMSE (MD: 1.16, 95% CI [0.91, 1.41], p = 0.0075); HAMD (MD: -2.63, 95% CI [-6.45, -1.20], p = 0.14); HAMA (SMD: -0.62, 95% CI [-0.91, -0.33], p < 0.001); ADL (MD: -0.56, 95% CI [-1.10, 2.22], p = 0.48).
rTMS has a positive effect on cognitive impairment and emotional abnormalities associated with ND. There is a significant difference in MoCA scores between rTMS applied to DLPFC and non-DLPFC. DLPFC may serve as a reliable stimulation target for treating non-motor symptoms related to ND (such as cognitive and emotional issues), which is beneficial for developing an rTMS treatment protocol with broad applicability for ND. However, due to the small number of included studies and the indirect nature of the comparison methods, we should interpret these results with caution.
目前，缺乏可靠证据证明重复经颅磁刺激（rTMS）在神经退行性疾病（ND）的认知和情感领域的有效性，导致缺乏统一有效的rTMS治疗方案或刺激靶点。本系统评价和荟萃分析总结现有证据，以评估针对背外侧前额叶皮质（DLPFC）和非DLPFC的rTMS在ND认知和情感方面的疗效。
对于两种常见的ND类型，即阿尔茨海默病（AD）和帕金森病（PD），我们从五个数据库中纳入了17项相关随机对照试验（RCT）。检索词包括rTMS、帕金森病、阿尔茨海默病、认知障碍和随机对照研究。两名独立评审员评估纳入文献的偏倚风险，进行数据提取并评估证据。使用蒙特利尔认知评估（MoCA）、简易精神状态检查表（MMSE）、汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）和日常生活活动能力（ADL）评估治疗效果。使用R软件分析数据以评估效应大小和95%置信区间（CI）。进行异质性检验以评估DLPFC和非DLPFC之间治疗效果的差异。
我们筛选了3467篇文章，确定了17项符合纳入标准的研究。汇总结果显示有显著效果：MoCA（MD：2.13，95%CI[0.75，3.52]，p<0.001）；MMSE（MD：1.16，95%CI[0.91，1.41]，p=0.0075）；HAMD（MD：-2.63，95%CI[-6.45，-1.20]，p=0.14）；HAMA（SMD：-0.62，95%CI[-0.91，-0.33]，p<0.001）；ADL（MD：-0.56，95%CI[-1.10，2.22]，p=0.48）。
rTMS对与ND相关的认知障碍和情感异常有积极作用。应用于DLPFC和非DLPFC的rTMS在MoCA评分上存在显著差异。DLPFC可能是治疗与ND相关的非运动症状（如认知和情感问题）的可靠刺激靶点，这有利于制定对ND具有广泛适用性的rTMS治疗方案。然而，由于纳入研究数量较少且比较方法具有间接性，我们应谨慎解读这些结果。
