Abstract
Repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation technique, has been considered as a potentially effective treatment for the cognitive impairment in patients with mild cognitive impairment (MCI) and Alzheimer’s Disease (AD). However, the effectiveness of this therapy is still under debate due to the variety of rTMS parameters and individual differences including distinctive stages of AD in the previous studies. The current meta-analysis is aiming to assess the cognitive enhancement of rTMS treatment on patients of MCI and early AD. Three datasets (PubMed, Web of Science and CKNI) were searched with relative terms and finally twelve studies with 438 participants (231 in the rTMS group and 207 in the control group) in thirteen randomized, double-blind and controlled trials were included. Random effects analysis revealed that rTMS stimulation significantly introduced cognitive benefits in patients of MCI and early AD compared with the control group (mean effect size, 1.17; 95% CI, 0.76 - 1.57). Most settings of rTMS parameters (frequency, session number, stimulation site number) significantly enhanced global cognitive function, and the results revealed that protocols with 10 Hz repetition frequency and DLPFC as the stimulation site for 20 sessions can already be able to produce cognitive improvement. The cognitive enhancement of rTMS could last for one month after the end of treatment and patients with MCI were likely to benefit more from the rTMS stimulation. Our meta-analysis added important evidence to the cognitive enhancement of rTMS in patients with MCI and early AD and discussed potential underlying mechanisms about the effect induced by rTMS.
Highlights
Alzheimer’s disease (AD) is the most common neurogenerative disorders, and is typically characterized by decline in cognition, behavior and activities of daily living
According to the subgroup analyses conducted to explore the proper stimulation patterns, most settings of repetitive transcranial magnetic stimulation (rTMS) parameters enhanced the global cognitive function, and the results revealed that rTMS protocols with stimulating frequency in 10 Hz and dorsolateral prefrontal cortex (DLPFC) as the stimulating rTMS on Mild cognitive impairment (MCI) and AD
Our meta-analysis provided evidence that rTMS therapy in patients with MCI or early AD can significantly improve global cognitive ability, and memory, executive function and language when compared to the control group
Summary
Alzheimer’s disease (AD) is the most common neurogenerative disorders, and is typically characterized by decline in cognition, behavior and activities of daily living. Mild cognitive impairment (MCI) is a prodromal stage of dementia, characterized by subjective cognitive deficits and objective memory impairment without impairment in daily activity (Petersen et al, 1999; Breton et al, 2019). The detrimental impact of Alzheimer’s disease and mild cognitive impairment on cognitive function in older adults has caused suffering of patients and burden on society. Repetitive transcranial magnetic stimulation (rTMS) has received increasing attention for its prominence effect on the intervention for cognitive function in AD and MCI (Birba et al, 2017; Chang et al, 2018; Lin et al, 2019; Chou et al, 2020). It has been reported that high frequencies (higher than 5 Hz) would increase cortical excitability and low frequencies (lower than 1 Hz) would suppress cortical excitability (Maeda et al, 2000)
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