Highlights
- •Repetitive transcranial magnetic stimulation (rTMS) can significantly improve the cognitive ability in patients with mild to moderate AD.
- •Stimulating multiple sites (mostly bilateral DLPFC) and long-term treatment are more effective in improving AD-associated cognitive performance.
- •High-frequency rTMS is more appropriate than low-frequency rTMS on treating AD.
- •Some novel interventional targets, like PC, may be a more effective therapeutic site
Abstract
Background
Although repetitive transcranial magnetic stimulation (rTMS) has been considered a
potentially effective treatment for cognitive impairment in patients with Alzheimer's
disease (AD), previous studies have produced inconsistent results. The objective of
this meta-analysis was to evaluate the effects of rTMS on cognitive function in patients
with AD.
Methods
PubMed, EMBASE, Web of Science, MEDLINE and Cochrane Central Register of Controlled
Trials (CENTRAL) were searched for relevant terms. Abstracts of all papers were carefully
reviewed, followed by data extraction, quality assessment, data synthesis and subgroup
analyses.
Result
A total of 12 studies with 231 patients were included, with 8 randomized controlled
studies and 4 self-controlled studies. Eleven studies used high frequency rTMS (≥
5 Hz), but only one study directly compared the difference between low-frequency (1 Hz)
and high-frequency (20 Hz). Random-effects analysis revealed that rTMS could significantly
improve cognition compared with sham-rTMS (SMD: 0.60, 95% CI: 0.35–0.85, P < .0001). In subgroup analyses, the effect for stimulation at a single target was
0.13 (95% CI: −0.35–0.62) and multiple targets 0.86 (95% CI: 0.18–1.54). Treatment
for ≤3 sessions produced an effect of 0.29 (95% CI: −1.04–1.62), whereas treatment
for ≥5 sessions produced an effect of 2.77 (95% CI: 2.22–3.32). No differences were
found for rTMS combined with medication or cognitive training.
Conclusions
rTMS can significantly improve cognitive ability in patients with mild to moderate
AD. Stimulation of multiple sites and long-term treatment are better at improving
AD-associated cognitive performance. Furthermore, some novel interventional targets,
like precuneus (PC), may be a more effective therapeutic site to improve memory in
AD.
Keywords
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Article info
Publication history
Published online: January 24, 2019
Accepted:
January 22,
2019
Received in revised form:
January 1,
2019
Received:
August 6,
2018
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
