Efficacy of repetitive transcranial magnetic stimulation on post-stroke cognitive impairment: A systematic and a network meta-analysis

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY International Journal of Geriatric Psychiatry Pub Date : 2024-06-26 DOI:10.1002/gps.6117

Xianying Liu, Hong Li, Shining Yang, Zhenghua Xiao, Qing Li, Feng Zhang, Jiang Ma

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Abstract

Objectives

This study aimed to evaluate the efficacy of different repetitive transcranial magnetic stimulation (rTMS) modes in stroke patients with cognitive impairment, and to rank the best option according to the outcome measures.

Methods

Literature was searched in PubMed, Cochrane Library, Web of Science, Embase, SinoMed, China National Knowledge Infrastructure, Wanfang Database, and VIP Database, from database inception to September 2023. We included randomized controlled trials (RCTs) investigating the efficacy of all rTMS modes for post-stroke cognitive impairment. The selected studies assessed at least one of the following outcome measures: Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), P300 latency and amplitude, and modified Barthel Index (MBI) or BI. Two researchers independently conducted data extraction. Quality assessment was performed using RevMan 5.3 software based on the Cochrane Collaboration's tool, and statistical analysis was conducted by GeMTC 0.14.3 software and Stata 17.0 software.

Results

The network meta-analysis included 74 RCTs with a total of 5478 patients. The best probability ranking indicated that intermittent theta burst stimulation (iTBS) was the most effective in enhancing MoCA, MMSE and MBI scores (85%, 54%, 42%, respectively), followed by 10 Hz rTMS (79%, 50%, 39%, respectively), for P300 amplitude, ≤1 Hz rTMS was ranked first (52%).

Conclusions

The current limited evidence suggests that iTBS may be the optimal approach for improving cognitive and daily life abilities of stroke patients, followed by 10 Hz rTMS, ≤1 Hz rTMS may be the preferred option for enhancing P300 amplitude.

Trail registration: PROSPERO 2023 CRD42023424771 available from: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=424771.

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重复经颅磁刺激对脑卒中后认知障碍的疗效：系统和网络荟萃分析。

研究目的本研究旨在评估不同重复经颅磁刺激（rTMS）模式对认知障碍脑卒中患者的疗效，并根据结果指标对最佳方案进行排序：方法：在PubMed、Cochrane Library、Web of Science、Embase、SinoMed、中国国家知识基础设施、万方数据库和VIP数据库中检索从数据库开始到2023年9月的文献。我们纳入了调查所有经颅磁刺激模式对卒中后认知障碍疗效的随机对照试验（RCT）。所选研究至少评估了以下一种结果指标：蒙特利尔认知评估（MoCA）、迷你精神状态检查（MMSE）、P300潜伏期和振幅、改良巴特尔指数（MBI）或BI。两名研究人员独立进行数据提取。质量评估使用基于 Cochrane 协作工具的 RevMan 5.3 软件进行，统计分析使用 GeMTC 0.14.3 软件和 Stata 17.0 软件进行：网络荟萃分析包括 74 项 RCT，共计 5478 名患者。最佳概率排名显示，间歇θ脉冲刺激（iTBS）对提高MoCA、MMSE和MBI评分最有效（分别为85%、54%和42%），其次是10 Hz经颅磁刺激（分别为79%、50%和39%），在P300振幅方面，≤1 Hz经颅磁刺激排名第一（52%）：目前有限的证据表明，iTBS可能是改善脑卒中患者认知和日常生活能力的最佳方法，其次是10赫兹经颅磁刺激，≤1赫兹经颅磁刺激可能是增强P300振幅的首选方法：PROSPERO 2023 CRD42023424771 可从以下网址获取：https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=424771。

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来源期刊

International Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

6.10

自引率

2.50%

发文量

168

审稿时长

4-8 weeks

期刊介绍： The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers. The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.