A randomized controlled trial of repetitive transcranial magnetic stimulation plus donepezil vs donepezil alone for mild to moderate cognitive impairment due to small vessel cerebrovascular disease.

Abstract

Cognitive impairment due to small vessel cerebrovascular disease (SVCVD) results in 35% to 67% of vascular dementia, which may be overlooked by healthcare providers due to its insidious onset. SVCVD involves chronic cerebral ischemia and hypoperfusion, endothelial dysfunction, and blood-brain barrier disruption, as well as interstitial fluid reflux obstruction. The purpose of this study was to investigate the clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) combined with donepezil hydrochloride (vs donepezil alone) in the treatment of mild-to-moderate cognitive impairment in patients with SVCVD. A cohort of 115 individuals with mild-to-moderate cognitive impairment due to SVCVD was purposefully selected and subsequently randomized into two groups: a test group and a control group. The test group received a combination of repetitive transcranial magnetic stimulation (rTMS) and oral donepezil hydrochloride (10mg/day), while the control group received oral donepezil alone (10mg/day). The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores were evaluated in both groups prior to and following the intervention. Following 6weeks of treatment, both groups demonstrated an enhancement in cognitive function. However, a statistically significant difference was observed between the test group and the control group (P < .05 on both the MMSE and the MOCA), favouring the test group. Compared to donepezil hydrochloride alone, the combination of repetitive transcranial magnetic stimulation (rTMS) and donepezil hydrochloride has a significantly greater effect on enhancing cognitive function among individuals experiencing mild-to-moderate cognitive impairment resulting from SVCVD.