Repetitive Transcranial Magnetic Stimulation Combined With Cognitive Training for Cognitive Function and Activities of Daily Living in Patients With Post-stroke Cognitive Impairment: A Systematic Review and Meta-Analysis

Ageing Research Reviews

Gao, Y., Qiu, Y., et al. (2023).

Ageing Research Reviews, 87, 101919.

This systematic review and meta-analysis investigates the effects of repetitive transcranial magnetic stimulation (rTMS) combined with cognitive training for individuals with stroke-associated cognitive impairment.

National Key R&D Program of China; Natural Science Foundation of Zhejiang Province (China); Shaoxing Bureau of Science and Technology (China)

From database inception to March 23, 2022

Randomized controlled trials and crossover trials

8

Combined treatments of rTMS and cognitive training demonstrated the following overall effects for adults with stroke-associated cognitive impairments:<br /> <ul> <li><span style="color: #333333;">large effects on global cognition (g = 0.78), executive function skills (g = 0.77), and working memory (g = 0.61);</span></li> <li><span style="color: #333333;">a medium effect on activities of daily living (ADLs; g = 0.42); and</span></li> <li><span style="color: #333333;">no effect on memory or attention.&nbsp;</span></li> </ul> <span style="color: #333333;">Limitations to this review include a high risk of bias for the majority of included studies (7 of 8), heterogeneity between studies regarding selected assessments, and small sample sizes.</span>

Combined treatments of rTMS and cognitive training demonstrated significantly larger improvements for individuals in the acute to subacute (g = 1.13) and subacute (g = 0.76) phases of stroke recovery when compared to individuals in the subacute to chronic (g = 0.54) and chronic phases (g = 0.71). <br /><br />Limitations to this review include a high risk of bias for the majority of included studies (7 of 8), heterogeneity between studies regarding selected assessments, and small sample sizes.

For combined treatments of rTMS and cognitive training, the number of treatment sessions, stimulation frequency, and stimulation site modulated outcomes. Specific findings included:<br /> <ul> <li><span style="color: #333333;">The estimated effects of low frequency rTMS (LF-rTMS; g = 0.98) were larger and more significant than high frequency rTMS (HF-rTMS; g = 0.79).</span></li> <li><span style="color: #333333;">The estimated effects of LF-rTMS delivered at the right dorsolateral prefrontal cortex (DLPFC; g = 1.16) were larger and more significant that LF-rTMS at the contralateral (g = 1.1) or left (g= - 0.13) DLPFC.&nbsp;</span></li> <li><span style="color: #333333;">The estimated effects of 40 sessions of LF-rTMS (g = 1.4) were significantly larger than 20 sessions (g = 0.98) or 10 sessions (g = -0.13).</span></li> <li><span style="color: #333333;">The estimated effects of 15 sessions of HF-rTMS (g = 1.13) were significantly larger than 20 sessions (g = 0.70) or 10 sessions (g = 0.16).</span></li> </ul> Limitations to this review include a high risk of bias for the majority of included studies (7 of 8), heterogeneity between studies regarding selected assessments, and small sample sizes.

Combined treatments of rTMS and cognitive training did not result in any serious adverse events. However, minor adverse events included transient dizziness, mild headache, tiredness, and scalp pain. Limitations to this review include a high risk of bias for the majority of included studies (7 of 8), heterogeneity between studies regarding selected assessments, and small sample sizes.