Network meta-analysis of non-pharmacological interventions for cognitive impairment after an ischemic stroke

Guangming Yang, Liyun Guo, Yuan Zhang, Shan Li
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Abstract

This study aims to evaluate the effectiveness of non-pharmacological interventions in improving cognitive function in patients with ischemic stroke through network meta-analysis.We searched databases including the Cochrane Library, PubMed, EmBase, and Web of Science for randomized controlled trials (RCTs) on non-pharmacological treatments to improve cognitive impairment following ischemic stroke. The publication date was up to 15 March 2023. Due to the insufficiency of included studies, supplementary searches for high-quality Chinese literature were performed in databases such as CNKI, WanFang Data, and VIP Chinese Science Journals Database. Two reviewers independently went through the literature, extracted data, and assessed the risk of bias in the included studies using the risk of bias assessment tool recommended by the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. By utilizing R 4.2.3 RStudio software and the GeMTC package, a Bayesian network meta-analysis was conducted to assess the improvement in Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores under a variety of non-pharmacological interventions.A total of 22 RCTs involving 2,111 patients and 14 different non-pharmacological treatments were included. These interventions were transcranial direct current stimulation (tDCS), reminiscence therapy (RT), remote ischemic conditioning (RIC), physical fitness training (PFT), intensive patient care program (IPCP), moderate-intensity continuous training + high-intensity interval training (MICT + HIIT), medium intensity continuous training (MICT), grip training (GT), acupuncture, cognitive behavioral therapy (CBT), cognitive rehabilitation training (CRT), high pressure oxygen (HPO), moxibustion, and repetitive transcranial magnetic stimulation (rTMS). The results of the network meta-analysis indicated that rTMS had the highest likelihood of being the most effective intervention for improving MMSE and MoCA scores.The evidence from this study suggests that rTMS holds promise for improving MMSE and MoCA scores in patients with cognitive impairment following ischemic stroke. However, further high-quality research is needed to confirm and validate this finding.
缺血性脑卒中后认知障碍非药物干预网络荟萃分析
本研究旨在通过网络荟萃分析评估非药物干预对改善缺血性脑卒中患者认知功能的有效性。我们检索了包括 Cochrane Library、PubMed、EmBase 和 Web of Science 在内的数据库,以了解有关改善缺血性脑卒中后认知障碍的非药物治疗的随机对照试验(RCT)。发表日期截至 2023 年 3 月 15 日。由于纳入的研究不足,我们在 CNKI、万方数据和 VIP 中文科学期刊数据库等数据库中对高质量的中文文献进行了补充检索。两名审稿人分别独立查阅文献、提取数据,并使用《干预措施系统综述手册》(Cochrane Handbook for Systematic Reviews of Interventions 5.1.0)推荐的偏倚风险评估工具对纳入研究的偏倚风险进行评估。通过使用 R 4.2.3 RStudio 软件和 GeMTC 软件包,我们进行了贝叶斯网络荟萃分析,以评估各种非药物干预措施对迷你精神状态检查(MMSE)和蒙特利尔认知评估(MoCA)分数的改善情况。这些干预措施包括经颅直流电刺激(tDCS)、回忆疗法(RT)、远程缺血调节(RIC)、体能训练(PFT)、患者强化护理计划(IPCP)、中等强度持续训练+高强度间歇训练(MICT + HIIT)、中强度连续训练(MICT)、握力训练(GT)、针灸、认知行为疗法(CBT)、认知康复训练(CRT)、高压氧(HPO)、艾灸和重复经颅磁刺激(rTMS)。网络荟萃分析的结果表明,经颅磁刺激最有可能成为改善 MMSE 和 MoCA 评分的最有效干预措施。这项研究的证据表明,经颅磁刺激有望改善缺血性卒中后认知障碍患者的 MMSE 和 MoCA 评分。然而,还需要进一步的高质量研究来证实和验证这一发现。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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