High-Frequency Repetitive Transcranial Magnetic Stimulation (HF-rTMS) on Overall Cognition in patients with Post-Stroke Cognitive Impairment: A Systematic Review and Meta-analysis

Abstract

Objective To comprehensively assess the recovery effects of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) in patients with post-stroke cognitive impairment (PSCI). Methods Six English and four Chinese databases were searched for relevant studies published up to January 2022. Randomized controlled trials (RCTs) of patients with PSCI treated with HF-rTMS were included. Included studies were assessed for the risk of bias through the Cochrane Intervention Systematic Review Manual 5.1.0. The meta-analysis was performed using RevMan 5.4 software. The PRISMA 2020 guidelines were followed. Results Sixty-one RCTs (4012 patients) were included. Montreal cognitive assessment (MoCA) score, mini-mental state examination (MMSE) score, event-related potential (P300) amplitude, Loewenstein occupational therapy cognitive assessment (LOTCA) score, and total effective rate of cognitive function were higher in the HF-rTMS group than in the control group at the end of the treatment period, and scores of Alzheimer's disease assessment scale-cognitive subscale (ADAS-Cog) and P300 latency were lower in the HF-rTMS group than in the control group. Fifty studies had selected the dorsolateral prefrontal cortex (DLPFC) as the stimulation site for HF-rTMS. Conclusion Compared to non-rTMS or sham rTMS, HF-rTMS not only improves the overall cognitive function of PSCI patients but also has better rehabilitation results.

Efficacy of repetitive transcranial magnetic stimulation in post-stroke cognitive impairment: an overview of systematic reviews

“…MMSE, MoCA, BI, MBI, RBMT, and LOTCA were among the primary outcome indicators used. Thirteen ( 31–41 , 43 , 47 ) articles reported financial support. Most studies concluded that rTMS has advantages in treating PSCI but emphasized the need for more, higher-quality studies to validate the results.…”

“…Therefore, the literature rankings published in 2023 were positioned as 17. The earliest publication date is 2021, containing five ( 31 , 33 , 34 , 42 , 46 ) studies; the latest is 2023, containing 10 ( 32 , 36–40 , 43–45 , 47 ). Meanwhile, there were two ( 35 , 41 ) studies in 2022.…”

“…The vital entries reported as missing in large numbers are entry 2 (41%), entry 7 (0%), entry 13 (12%), and entry 15 (41%). The following were the primary causes: (1) only seven ( 36–38 , 40 , 43 , 46 , 47 ) articles were numbered and registered in the program before the evaluation; (2) the reasons for the exclusion list are not provided in all the articles; (3) only two ( 40 , 46 ) articles considered the risk of study bias when discussing or analyzing the results of each study; (4) all articles were searched without consulting experts in the relevant fields; and (5) 10 ( 31 , 33 , 36 , 39–44 , 47 ) articles do not describe the likelihood of the existence of publication bias in the small-sample studies and the severity of their impacts. The non-vital entries reported as missing in large numbers are entry 3 (0%), entry 10 (0%), entry 12 (29%), and entry 14 (47%).…”

“…The non-vital entries reported as missing in large numbers are entry 3 (0%), entry 10 (0%), entry 12 (29%), and entry 14 (47%). The main reasons were as follows: (1) none of the studies explained the reasons for the inclusion of RCT; (2) all of the literature did not describe the essential characteristics of the included studies in detail; (3) only six ( 36–38 , 41 , 46 , 47 ) articles assessed the risk of bias of the included studies on the potential impact on the study results; (4) The authors of the nine ( 33 , 35 , 37 , 41–46 ) studies did not provide a satisfactory explanation or discussion of the heterogeneity in the results of the MAs/SRs ( Supplementary Table S3 ). Seventeen articles had a score ranging from 5 to 11.…”

“…Seventeen articles had a score ranging from 5 to 11. Among them, three ( 33 , 42 , 44 ) studies scored 5, one ( 31 ) literature scored 6, one ( 41 ) literature scored 6.5, four ( 35 , 39 , 43 , 45 ) articles scored 7, one ( 34 ) literature scored 8, one ( 37 ) literature scored 9, three ( 32 , 36 , 40 ) articles scored 10, and three ( 38 , 46 , 47 ) articles scored 11. Refer to Table 2 for details.…”