背景:非侵入性脑刺激(NIBS)联合认知训练(CT)可能在改善阿尔茨海默病(AD)和轻度认知障碍(MCI)患者的认知功能方面显示出一定的前景。然而,涉及NIBS联合CT的临床试验或荟萃分析数据显示有争议的结果.本系统评价和荟萃分析的目的是评估NIBS联合CT对改善AD和MCI患者整体认知和其他特定认知领域的短期和长期影响。
方法:本系统评价和荟萃分析按照系统评价和荟萃分析(PRISMA)指南的首选报告项目进行。五个电子数据库,包括PubMed,WebofScience,EBSCO,从成立到2023年11月20日,搜索了Cochrane图书馆和Embase。采用PEDro量表和Cochrane的偏倚风险评估对纳入研究的偏倚风险和方法学质量进行评价。所有统计分析均使用ReviewManager5.3进行。
结果:我们纳入了15项研究,共685名患者。PEDro量表用于评估方法学质量,平均得分为7.9分。荟萃分析结果显示NIBS联合CT对改善AD和MCI患者的整体认知功能有明显的疗效(SMD=0.52,95%CI(0.18,0.87),p=0.003),尤其是重复经颅磁刺激(rTMS)联合CT(SMD=0.46,95%CI(0.14,0.78),p=0.005)。与NIBS联合CT组相比,AD可实现整体认知改善(SMD=0.77,95%CI(0.19,1.35),p=0.01)。经颅直流电刺激(tDCS)联合CT可以改善AD和MCI的语言功能(SMD=0.29,95%CI(0.03,0.55),p=0.03)。在评估后续行动中,rTMS联合CT在整体认知中对AD和MCI表现出更大的治疗反应(SMD=0.55,95%CI(0.09,1.02),p=0.02)。AD可以实现整体认知(SMD=0.40,95%CI(0.03,0.77),p=0.03)和注意力/工作记忆(SMD=0.72,95%CI(0.23,1.20),p=0.004)NIBS联合CT组评估随访后的改善。
结论:总体而言,NIBS联合CT,特别是rTMS结合CT,对改善全球认知有短期和后续效应,主要在AD患者中。tDCS联合CT在改善AD和MCI语言功能方面具有优势。未来更多的研究需要评估NIBS联合CT对认知恶化患者其他特定认知领域的认知效果。
BACKGROUND: Non-invasive brain stimulation (NIBS) combined with cognitive training (CT) may have shown some prospects on improving cognitive function in patients with Alzheimer\'s disease (AD) and mild cognitive impairment (MCI). However, data from clinical trials or meta-analysis involving NIBS combined with CT have shown controversial results. The aim of this systematic
review and meta-analysis was to evaluate short-term and long-term effects of NIBS combined with CT on improving global cognition and other specific cognitive domains in patients with AD and MCI.
METHODS: This systematic
review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five electronic databases including PubMed, Web of Science, EBSCO, Cochrane Library and Embase were searched up from inception to 20 November 2023. The PEDro scale and the Cochrane\'s risk of bias assessment were used to evaluate risk of bias and methodological quality of included studies. All statistical analyses were conducted with
Review Manager 5.3.
RESULTS: We included 15 studies with 685 patients. The PEDro scale was used to assess methodological quality with a mean score of 7.9. The results of meta-analysis showed that NIBS combined with CT was effective on improving global cognition in AD and MCI (SMD = 0.52, 95% CI (0.18, 0.87), p = 0.003), especially for patients accepting repetitive transcranial magnetic stimulation (rTMS) combined with CT (SMD = 0.46, 95% CI (0.14, 0.78), p = 0.005). AD could achieve global cognition improvement from NIBS combined with CT group (SMD = 0.77, 95% CI (0.19, 1.35), p = 0.01). Transcranial direct current stimulation (tDCS) combined with CT could improve language function in AD and MCI (SMD = 0.29, 95% CI (0.03, 0.55), p = 0.03). At evaluation follow-up, rTMS combined with CT exhibited larger therapeutic responses to AD and MCI in global cognition (SMD = 0.55, 95% CI (0.09, 1.02), p = 0.02). AD could achieve global cognition (SMD = 0.40, 95% CI (0.03, 0.77), p = 0.03) and attention/working memory (SMD = 0.72, 95% CI (0.23, 1.20), p = 0.004) improvement after evaluation follow-up from NIBS combined with CT group.
CONCLUSIONS: Overall, NIBS combined with CT, particularly rTMS combined with CT, has both short-term and follow-up effects on improving global cognition, mainly in patients with AD. tDCS combined with CT has advantages on improving language function in AD and MCI. Future more studies need evaluate cognitive effects of NIBS combined with CT on other specific cognitive domain in patients with cognitive deterioration.