The Effect of Noninvasive Brain Stimulation on Poststroke Cognitive Function: A Systematic Review

Lieshout, Eline C C van; Hooijdonk, Roel F van; Dijkhuizen, Rick M.; Visser-Meily, J. M. A.; Nijboer, Tanja C.W.

doi:10.1177/1545968319834900

Cited by 22 publications

(17 citation statements)

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“…Among the excluded articles, 2 had less than 5 sessions or 5 days of NIBS [ 28 , 29 ]. Not only did this not adhere to the recommended schedule for treatment of depression, which has been highly evidenced in recent years, but it is also suggested that long-term cognitive improvement is likely related to the number of stimulation session/days, with more stimulation sessions resulting in a longer-lasting response [ 30 ]. In addition, one study evaluated a functional independence measure with the stimulation site being the primary motor cortex.…”

Section: Resultsmentioning

confidence: 99%

The Effect of Non-Invasive Brain Stimulation (NIBS) on Attention and Memory Function in Stroke Rehabilitation Patients: A Systematic Review and Meta-Analysis

et al. 2021

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Background: In recent years, the potential of non-invasive brain stimulation (NIBS) for therapeutic effects on cognitive functions has been explored for populations with stroke. There are various NIBS methods depending on the stimulation site and stimulation parameters. However, there is no systematic NIBS review of post-stroke cognitive impairment with a focus on stimulation sites and stimulation parameters. The purpose of this study is to conduct a systematic review and meta-analysis on effectiveness and safety of NIBS for cognitive impairment after a stroke to obtain new insights. This study was prospectively registered with the PROSPERO database of systematic reviews (CRD42020183298). Methods: All English articles from MEDLINE, Scopus, CINAHL, Embase, PsycINFO, and CENTRAL were searched from inception up to 31 December 2020. Randomized and prospective controlled trials were included for the analysis. Studies with at least five individuals post-stroke, whereby at least five sessions of NIBS were provided and using standardized neuropsychological measurement of cognition, were included. We assessed the methodological quality of selected studies as described in the Physiotherapy Evidence Database (PEDro) scoring system. Results: A total of 10 studies met eligibility criteria. Six studies used repetitive transcranial magnetic stimulation (rTMS) and four studies used transcranial direct current stimulation (tDCS). The pooled sample size was 221 and 196 individuals who received rTMS and tDCS respectively. Eight studies combined general rehabilitation, cognitive training, or additional therapy with NIBS. In rTMS studies, target symptoms included global cognition (n = 4), attention (n = 3), memory (n = 4), working memory (WM) (n = 3), and executive function (n = 2). Five studies selected the left dorsolateral prefrontal cortex (DPLFC) as the stimulation target. One rTMS study selected the right DLPFC as the inhibitory stimulation target. Four of six studies showed significant improvement. In tDCS studies, target symptoms included global cognition (n = 2), attention (n = 4), memory (n = 2) and WM (n = 2). Three studies selected the frontal area as the stimulation target. All studies showed significant improvement. In the meta-analysis, rTMS showed a significant effect on attention, memory, WM and global cognition classified by neuropsychological tests. On the other hand, tDCS had no significant effect. Conclusions: In post-stroke patients with deficits in cognitive function, including attention, memory, and WM, NIBS shows promising positive effects. However, this effect is limited, suggesting that further studies are needed with more precision in stimulation sites and stimulation parameters. Future studies using advanced neurophysiological and neuroimaging tools to allow for a network-based approach to treat cognitive symptoms post-stroke with NIBS are warranted.

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Section: Resultsmentioning

confidence: 99%

The Effect of Non-Invasive Brain Stimulation (NIBS) on Attention and Memory Function in Stroke Rehabilitation Patients: A Systematic Review and Meta-Analysis

et al. 2021

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“…The reason why we increased the total number of stimuli to 2,000 was to consider the possibility that increasing the number of stimuli might increase the efficacy and duration of rTMS treatments. A systematic review also concluded that long-term cognitive improvements are likely related to the number of stimulation sessions/days, where more stimulation sessions result in longer-lasting stimulation effects (van Lieshout et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Effects of rTMS Treatment on Cognitive Impairment and Resting-State Brain Activity in Stroke Patients: A Randomized Clinical Trial

Yin

Liu

Zhang

et al. 2020

Front. Neural Circuits

118

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Background: Repetitive transcranial magnetic stimulation (rTMS) has been employed for motor function rehabilitation for stroke patients, but its effects on post-stroke cognitive impairment (PSCI) remains controversial. Objective: To identify the effects of rTMS intervention on PSCI patients and its potential neural correlates to behavioral improvements. Methods: We recruited 34 PSCI patients for 20 sessions of 10 Hz rTMS or nostim control treatments over the left dorsal lateral prefrontal cortex (DLPFC). Cognitive function was evaluated with the Montreal Cognitive Assessment Scale, Victoria Stroop Test, Rivermead Behavior Memory Test, and Activities of Daily Living (ADL) assessed with the Modified Barthel Index. 14 patients received functional MRI scan, a useful non-invasive technique of determining how structurally segregated and functionally specialized brain areas were interconnected, which was reflected by blood oxygenation level-dependent signals. The amplitude of low-frequency fluctuation (ALFF) and functional connectivity (FC) were applied as the analytical approaches, which were used to measure the resting-state brain activity and functional connection. Results: rTMS improved cognitive functions and ADLs for PSCI patients relative to patients who received no-stim control treatment. The cognitive improvements correlated to increased ALFF of the left medial prefrontal cortex, and increased FC of right medial prefrontal cortex and right ventral anterior cingulate cortex. Conclusion: 10 Hz rTMS at DLPFC could improve cognitive function and quality of life for PSCI patients, which is associated with an altered frontal cortical activity.

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“…Since the current study is a conceptually novel approach, we estimated the necessary sample size based on the results of previous neglect studies that combined neglect treatment with NIBS that aimed at such ‘re-balancing’ in repeated sessions. The review of Van Lieshout and colleagues [ 52 ] reports four such RCT’s for which effect sizes are known or could be calculated. Cohen’s d ranged from 1.07-5.27 in two rTMS studies [ 53 , 54 ], 1.48-7.14 in two TBS studies [ 54 , 55 ], and 1.50-2.35 in one tDCS study [ 56 ].…”

Section: Methodsmentioning

confidence: 99%

Study protocol of transcranial electrical stimulation at alpha frequency applied during rehabilitation: A randomized controlled trial in chronic stroke patients with visuospatial neglect

et al. 2022

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Background A frequent post stroke disorder in lateralized attention is visuospatial neglect (VSN). As VSN has a strong negative impact on recovery in general and independence during daily life, optimal treatment is deemed urgent. Next to traditional stroke treatment, non-invasive brain stimulation offers the potential to facilitate stroke recovery as a complementary approach. In the present study, visual scanning training (VST; the current conventional treatment) will be combined with transcranial alternating current stimulation (tACS) to evaluate the additive effects of repeated sessions of tACS in combination with six-weeks VST rehabilitation. Methods In this double-blind randomized placebo-controlled intervention study (RCT), we will compare the effects of active tACS plus VST to sham (placebo) tACS plus VST, both encompassing 18 VST training sessions, 40 minutes each, during 6 weeks. Chronic stroke patients with VSN (> 6 months post-stroke onset) are considered eligible for study participation. In total 22 patients are needed for the study. The primary outcome is change in performance on a cancellation task. Secondary outcomes are changes in performance on a visual detection task, two line bisection tasks, and three measures to assess changes in activities of daily living. Assessment is at baseline, directly after the first and ninth training session, after the last training session (post training), and 1 week and 3 months after termination of the training (follow-up). Discussion If effective, a tACS-VST rehabilitation program could be implemented as a treatment option for VSN. Trial registration ClinicalTrials.gov; registration number: NCT05466487; registration date: July 18, 2022 retrospectively registered; https://clinicaltrials.gov/ct2/show/NCT05466487

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The Effect of Noninvasive Brain Stimulation on Poststroke Cognitive Function: A Systematic Review

Abstract: Supplementary material for this article is available on the Neurorehabilitation & Neural Repair website along with the online version of this article.

Cited by 22 publications

References 84 publications

The Effect of Non-Invasive Brain Stimulation (NIBS) on Attention and Memory Function in Stroke Rehabilitation Patients: A Systematic Review and Meta-Analysis

The Effect of Non-Invasive Brain Stimulation (NIBS) on Attention and Memory Function in Stroke Rehabilitation Patients: A Systematic Review and Meta-Analysis

Effects of rTMS Treatment on Cognitive Impairment and Resting-State Brain Activity in Stroke Patients: A Randomized Clinical Trial

Study protocol of transcranial electrical stimulation at alpha frequency applied during rehabilitation: A randomized controlled trial in chronic stroke patients with visuospatial neglect

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