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

Abstract

Objective:To systematically assess the effects of Noninvasive Brain Stimulation (NIBS) on post-stroke cognitive impairment (PSCI) and to compare the efficacy of two different NIBS.MethodsComputer searches of PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Chinese Biomedical literature Service System (SinoMed), and Wanfang Database were conducted using a combination of free words and subject terms. The search was conducted from the database creation date to 27 November 2022. The risk of bias in the included literature was assessed using the Cochrane Risk Assessment Scale. The quality of the included literature was assessed using the physiotherapy evidence database (PEDro) scale. A standard meta-analysis of study data for each outcome indicator was performed using RevMan 5.4 software. Network meta-analysis was performed using State 14.0 according to the Bayesian framework.ResultsA total of 18 studies involving 809 patients were included. Meta-analysis shows NIBS significantly improved montreal cognitive assessment (MoCA) scores (standardized mean difference [SMD] = 0.76, 95% confidence interval (CI) 0.49–1.02, P < 0.05), mini-mental state examination (MMSE) scores (SMD = 0.72, 95% CI 0.25–1.20, P < 0.05), and modified barthel index (MBI) and functional independence measurement (FIM) scores (SMD = 0.33, 95% CI 0.11–0.54, P < 0.05) in patients with PSCI. The surface under the cumulative ranking curve (SUCRA) of different NIBS in improving MoCA scores were in the order of transcranial direct current stimulation (tDCS) (SUCRA = 92.4%) and transcranial magnetic stimulation (TMS) (SUCRA = 57.6%). The SUCRA of different NIBS in improving MMSE scores were in the order of tDCS (SUCRA = 81.6%) and TMS (SUCRA = 67.3%). The SUCRA of different NIBS in improving MBI and FIM scores were in the order of tDCS (SUCRA = 78.6%) and TMS (SUCRA = 65.3%).ConclusionThe available evidence suggests that NIBS improves cognitive impairment. tDCS appeared more effective than TMS for cognitive function and activities of daily living in PSCI patients. Limited by the number of included studies, more large-sample, multicentre, double-blind, high-quality randomized controlled clinical trials are needed to further confirm this study's results.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42022372354.

Effect of transcranial direct current stimulation combined with transcutaneous auricular vagus nerve stimulation on poststroke cognitive impairment: a study protocol for a randomised controlled trial

“…The sample size was calculated on the basis of the MoCA score from a previous meta-analysis study, and the effect size of tDCS intervention on the cognitive function of PSCI patients is approximately 0.27–1.45 18. Then, we imported the result into the Gpower software.…”

“…Therefore, there is increasing interest in non-drug therapies. Non-invasive brain stimulation (NIBS) is an effective treatment for PSCI that can gradually improve cognitive function 17 18…”

Novel Technologies Targeting the Rehabilitation of Neurological Disorders

“…Focused transcranial ultrasound stimulation (TUS) is a highly accurate NIBS modality, which can straightly focus low-intensity sound waves to deeper cerebral areas (Folloni, 2022). With the potential of a short and offline therapeutic program, TUS based on its advantages can be a prospective treatment for neurological diseases, like stroke and Parkinson's (Wang et al, 2020;Folloni, 2022;Wang Y. et al, 2022). Presently, it's still in the initial exploratory phase, whose mechanisms are yet to be explored for extensible application.…”

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

“…Post-stroke cognitive impairment (PSCI) refers to the clinical symptoms where cognitive function is affected to varying degrees after a stroke and lasts up to 6 months ( 1 , 2 ). According to a survey, it was found that between 17 and 92% of stroke patients experience cognitive dysfunction 3 months after the onset of the condition, which has a significant negative impact on the life quality and activities of daily living (ADL) of patients ( 3 ).…”