Improvement of poststroke cognitive impairment by intermittent theta bursts: A double‐blind randomized controlled trial

Abstract

Background: Intermittent theta burst stimulation (iTBS) is known to improve cognitive impairment caused by Alzheimer's disease and Parkinson's disease, but studies are lacking with respect to the efficacy of iTBS on poststroke cognitive impairment (PSCI).Objective: This study was conducted to investigate the effect of left dorsolateral prefrontal cortex (DLPFC) iTBS on improving cognitive function in stroke patients.Methods: Fifty-eight patients with PSCI are randomly divided into iTBS (n = 28) and sham stimulation groups (n = 30). Both groups receive routine cognitive-related rehabilitation. The iTBS group is treated with iTBS intervention of the left DLPFC, and the sham stimulation group is treated with the same parameters at the same site for 2 weeks. Outcome measures are assessed at baseline (T0) and immediately after the last intervention (T1) by mini-mental state examination (MMSE), Oxford cognitive screen, and event-related potential P300.Results: There are no differences in baseline clinical characteristics between the two groups. After intervention, the MMSE scores and P300 amplitude increase significantly for both groups, and the P300 incubation period reduces significantly. The change value of the iTBS group is significantly higher than that of sham stimulation group (p < .05). Compared with the sham stimulation group, the iTBS group has more significant changes in semantic comprehension and executive function (p < .05). Conclusion: iTBS can effectively and safely improve overall cognitive impairment in stroke patients, including semantic understanding and executive function, and it also has a positive impact on memory function. Future randomized controlled studies with large samples and long-term follow-up should be conducted to further validate the results of the present study K E Y W O R D S cognitive disorder, double-blind randomized controlled trial, intermittent theta burst stimulation, stroke This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Systematic review and network meta-analysis of effects of noninvasive brain stimulation on post-stroke cognitive impairment

“…A total of 814 studies were obtained, including 353 in English and 461 in Chinese. 18 studies (Kim et al, 2010 ; Lu et al, 2015 ; Yun et al, 2015 ; Shaker et al, 2018 ; Yin et al, 2018 ; Zeng et al, 2019 ; Zhang and Zou, 2019 ; Liu et al, 2020 , 2021 ; Li Y. et al, 2020 ; Ma et al, 2020 ; Ai et al, 2021 ; Li H. et al, 2021 ; Zhang et al, 2021 ; Chen et al, 2022 ; Ko et al, 2022 ; Li W. et al, 2022 ; Yan et al, 2022 ) were finally included, including 9 in English (Kim et al, 2010 ; Lu et al, 2015 ; Yun et al, 2015 ; Shaker et al, 2018 ; Liu et al, 2020 ; Li Y. et al, 2020 ; Li H. et al, 2021 ; Ko et al, 2022 ; Li W. et al, 2022 ) and 9 in Chinese (Yin et al, 2018 ; Zeng et al, 2019 ; Zhang and Zou, 2019 ; Ma et al, 2020 ; Ai et al, 2021 ; Liu et al, 2021 ; Zhang et al, 2021 ; Chen et al, 2022 ; Yan et al, 2022 ). The literature selection process is shown in Figure 1 .…”

“…All studies were blinded to treatment participants. Ten studies (Kim et al, 2010 ; Yun et al, 2015 ; Yin et al, 2018 ; Zhang and Zou, 2019 ; Liu et al, 2020 , 2021 ; Li Y. et al, 2020 ; Ai et al, 2021 ; Ko et al, 2022 ; Li W. et al, 2022 ) were blinded to assessors. The results of all studies were complete and not selectively reported.…”

“…Eight studies (Yun et al, 2015 ; Zeng et al, 2019 ; Liu et al, 2020 , 2021 ; Li Y. et al, 2020 ; Zhang et al, 2021 ; Chen et al, 2022 ; Li W. et al, 2022 ) reported MMSE scores in patients with PSCI after treatment. The results showed that MMSE scores were better in the NIBS group than in the sham stimulation group, with a statistically significant difference (SMD = 0.72, 95% CI 0.25–1.20, P < 0.05).…”

“…The network relationships for the different NIBS, using MMSE as the outcome indicator, are shown in Figure 7A . Four of the included studies (Yun et al, 2015 ; Zeng et al, 2019 ; Liu et al, 2021 ; Chen et al, 2022 ) used tDCS as the intervention, and four (Liu et al, 2020 ; Li Y. et al, 2020 ; Zhang et al, 2021 ; Li W. et al, 2022 ) used TMS as the intervention. The SUCRA of different NIBS in improving MMSE scores were in the order of tDCS (SUCRA = 81.6%) and TMS (SUCRA = 67.3%) ( Figure 7B ).…”

“…Six studies (Lu et al, 2015 ; Yin et al, 2018 ; Li Y. et al, 2020 ; Ai et al, 2021 ; Liu et al, 2021 ; Li W. et al, 2022 ) reported that a few patients experienced transient dizziness, pain, and pins and needles, and sneezing during treatment. The patients could be relieved after rest and did not affect the treatment.…”