Efficacy and safety of transcranial magnetic stimulation on cognition in mild cognitive impairment, Alzheimer's disease, Alzheimer's disease-related dementias, and other cognitive disorders: a systematic review and meta-analysis.

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY International psychogeriatrics Pub Date : 2024-10-01 DOI:10.1017/S1041610224000085

Sandeep R Pagali, Rakesh Kumar, Allison M LeMahieu, Michael R Basso, Bradley F Boeve, Paul E Croarkin, Jennifer R Geske, Leslie C Hassett, John Huston, Simon Kung, Brian N Lundstrom, Ronald C Petersen, Erik K St Louis, Kirk M Welker, Gregory A Worrell, Alvaro Pascual-Leone, Maria I Lapid

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Abstract

Objective: We aim to analyze the efficacy and safety of TMS on cognition in mild cognitive impairment (MCI), Alzheimer's disease (AD), AD-related dementias, and nondementia conditions with comorbid cognitive impairment.

Design: Systematic review, Meta-Analysis SETTING: We searched MEDLINE, Embase, Cochrane database, APA PsycINFO, Web of Science, and Scopus from January 1, 2000, to February 9, 2023.

Participants and interventions: RCTs, open-label, and case series studies reporting cognitive outcomes following TMS intervention were included.

Measurement: Cognitive and safety outcomes were measured. Cochrane Risk of Bias for RCTs and MINORS (Methodological Index for Non-Randomized Studies) criteria were used to evaluate study quality. This study was registered with PROSPERO (CRD42022326423).

Results: The systematic review included 143 studies (n = 5,800 participants) worldwide, encompassing 94 RCTs, 43 open-label prospective, 3 open-label retrospective, and 3 case series. The meta-analysis included 25 RCTs in MCI and AD. Collectively, these studies provide evidence of improved global and specific cognitive measures with TMS across diagnostic groups. Only 2 studies (among 143) reported 4 adverse events of seizures: 3 were deemed TMS unrelated and another resolved with coil repositioning. Meta-analysis showed large effect sizes on global cognition (Mini-Mental State Examination (SMD = 0.80 [0.26, 1.33], p = 0.003), Montreal Cognitive Assessment (SMD = 0.85 [0.26, 1.44], p = 0.005), Alzheimer's Disease Assessment Scale-Cognitive Subscale (SMD = -0.96 [-1.32, -0.60], p < 0.001)) in MCI and AD, although with significant heterogeneity.

Conclusion: The reviewed studies provide favorable evidence of improved cognition with TMS across all groups with cognitive impairment. TMS was safe and well tolerated with infrequent serious adverse events.

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经颅磁刺激对轻度认知障碍、阿尔茨海默病、阿尔茨海默病相关痴呆和其他认知障碍患者认知的疗效和安全性：一项系统综述和荟萃分析

目的：分析经颅磁刺激对轻度认知障碍（MCI）、阿尔茨海默病（AD）、AD相关痴呆和合并认知障碍的非痴呆患者认知功能的疗效和安全性。环境：我们检索了MEDLINE、Embase、Cochrane数据库、APA PsycINFO、Web of Science和Scopus，检索时间为2000年1月1日至2023年2月9日。参与者和干预措施：包括报告经颅磁刺激干预后认知结果的随机对照试验、开放标签研究和病例系列研究。测量：测量认知和安全结果。采用Cochrane rct偏倚风险和未成年人（非随机研究方法学指数）标准评价研究质量。本研究已在PROSPERO注册（CRD42022326423）。结果：系统评价纳入全球143项研究（n = 5800名受试者），包括94项随机对照试验，43项开放标签前瞻性研究，3项开放标签回顾性研究和3个病例系列。荟萃分析包括25项MCI和AD的随机对照试验。总的来说，这些研究提供了经颅磁刺激在诊断组中改善整体和特定认知测量的证据。143个研究中只有2个报告了4个癫痫发作不良事件：3个被认为与经颅磁刺激无关，另一个通过线圈重新定位解决。meta分析显示，MCI和AD的整体认知(迷你精神状态检查（SMD = 0.80 [0.26, 1.33], p = 0.003）、蒙特利尔认知评估（SMD = 0.85 [0.26, 1.44], p = 0.005）、阿尔茨海默病评估量表-认知子量表（SMD = -0.96 [-1.32, -0.60], p < 0.001）的效应量很大，尽管存在显著异质性。结论：回顾的研究提供了有利的证据，证明经颅磁刺激可以改善所有认知障碍组的认知能力。经颅磁刺激是安全且耐受性良好的，很少发生严重的不良事件。

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来源期刊

International psychogeriatrics 医学-精神病学

CiteScore

9.10

自引率

8.60%

发文量

217

审稿时长

3-6 weeks

期刊介绍： A highly respected, multidisciplinary journal, International Psychogeriatrics publishes high quality original research papers in the field of psychogeriatrics. The journal aims to be the leading peer reviewed journal dealing with all aspects of the mental health of older people throughout the world. Circulated to over 1,000 members of the International Psychogeriatric Association, International Psychogeriatrics also features important editorials, provocative debates, literature reviews, book reviews and letters to the editor.