Comparative efficacy of non-invasive brain stimulation on cognition function in patients with mild cognitive impairment: A systematic review and network meta-analysis

IF 12.5 1区医学 Q1 CELL BIOLOGY

Ageing Research Reviews Pub Date : 2024-09-19 DOI:10.1016/j.arr.2024.102508

Hong Liu , Mengyuan Wu , Haoyu Huang , Xiaolin Chen , Peiling Zeng , Ying Xu

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引用次数: 0

Abstract

Background

Mild cognitive impairment (MCI) is a critical time window for implementing prevention strategies to attenuate or delay cognitive decline. Non-invasive brain stimulation (NIBS) techniques are promising non-pharmacological therapies for improving the cognitive function of MCI, but it is unclear which type of NIBS protocol is most effective. This study aimed to compare and rank the beneficial effect of different NIBS methods/protocols on cognitive function and examine the acceptability of NIBS in patients with MCI.

Methods

Electronic search of PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure, Wanfang Database, and Chongqing VIP Database up to November 2023. Patients with diagnosis of MCI were included. The primary outcomes were acceptability and pre-post treatment changes in global cognitive function, and the secondary outcomes were specific cognitive domains (language and executive function). All network meta‑analysis procedures were performed under the frequentist model. A protocol for this systematic review was registered in PROSPERO (Registration number: CRD42023441448).

Results

A network meta-analysis was conducted on 19 eligible RCTs consisting of 599 subjects. Compared with the sham stimulation, Repetitive Transcranial Magnetic Stimulation over the Bilateral dorsolateral prefrontal cortex (rTMS-F3F4) showed the strongest improvement in global cognitive function in MCI patients (SMD =1.52[95 %CIs =0.49–2.56]), followed by rTMS over the left dorsolateral prefrontal cortex (rTMS-F3) (SMD =1.25[95 %CIs =0.57–1.93]); Moreover, rTMS-F3F4 showed more significant efficacy in language function (SMD =0.96[95 %CIs = 0.20–1.72]); No statistically significant differences were found among the other cognitive domains. Compared with the rTMS-F4, rTMS-F3F4 showed a stronger improvement in global cognitive function in MCI patients (SMD =1.80[95 %CIs =0.02–3.59]). Similar results were obtained in subgroup analyses of cognitive function. All the methods were well-tolerated with an acceptable safety profile.

Conclusion

The present findings provide evidence of the benefits of NIBS, especially TMS stimulating the bilateral dorsolateral prefrontal cortex, for the beneficial effect on cognitive and language function in patients with MCI. However, because few studies were available for inclusion, additional well-designed, large-scale RCTs are warranted to support exploring longer-term dynamic effects.

查看原文本刊更多论文

非侵入性脑部刺激对轻度认知障碍患者认知功能的疗效比较：系统综述和网络荟萃分析。

背景：轻度认知功能障碍（MCI）是实施预防策略以减轻或延缓认知功能衰退的关键时间窗口。非侵入性脑刺激（NIBS）技术是一种很有前景的非药物疗法，可改善 MCI 的认知功能，但目前还不清楚哪种类型的 NIBS 方案最有效。本研究旨在比较不同的 NIBS 方法/方案对认知功能的有益影响并对其进行排序，同时考察 MCI 患者对 NIBS 的接受程度：电子检索：PubMed、Cochrane图书馆、EMBASE、中国国家知识基础设施、万方数据库和重庆VIP数据库（截至2023年11月）。纳入诊断为 MCI 的患者。研究的主要结果是整体认知功能的可接受性和治疗前后的变化，次要结果是特定的认知领域（语言和执行功能）。所有网络荟萃分析程序均在频数模型下进行。本系统综述的方案已在 PROSPERO 注册（注册号：CRD42023441448）：结果：对 19 项符合条件的 RCT（包括 599 名受试者）进行了网络荟萃分析。与假刺激相比，双侧背外侧前额叶皮层重复经颅磁刺激（rTMS-F3F4）对 MCI 患者整体认知功能的改善最明显（SMD =1.52[95%CIs =0.49 to 2.56]），其次是 rTMS-F3F4。56]），其次是经颅磁刺激左侧背外侧前额叶皮层（rTMS-F3）（SMD =1.25[95%CIs =0.57 to 1.93]）；此外，经颅磁刺激-F3F4在语言功能方面的疗效更为显著（SMD =0.96[95%CIs = 0.20 to 1.72]）；其他认知领域之间没有发现显著的统计学差异。与经颅磁刺激-F4相比，经颅磁刺激-F3F4对MCI患者的整体认知功能改善更明显（SMD =1.80[95%CIs =0.02 to 3.59]）。认知功能的亚组分析也得出了类似的结果。所有方法的耐受性良好，安全性可接受：目前的研究结果证明了 NIBS（尤其是刺激双侧背外侧前额叶皮层的 TMS）对 MCI 患者认知和语言功能的益处。然而，由于可供纳入的研究较少，因此有必要进行更多设计良好的大规模 RCT 研究，以支持对长期动态效应的探索。

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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来源期刊

Ageing Research Reviews 医学-老年医学

CiteScore

19.80

自引率

2.30%

发文量

216

审稿时长

55 days

期刊介绍： With the rise in average human life expectancy, the impact of ageing and age-related diseases on our society has become increasingly significant. Ageing research is now a focal point for numerous laboratories, encompassing leaders in genetics, molecular and cellular biology, biochemistry, and behavior. Ageing Research Reviews (ARR) serves as a cornerstone in this field, addressing emerging trends. ARR aims to fill a substantial gap by providing critical reviews and viewpoints on evolving discoveries concerning the mechanisms of ageing and age-related diseases. The rapid progress in understanding the mechanisms controlling cellular proliferation, differentiation, and survival is unveiling new insights into the regulation of ageing. From telomerase to stem cells, and from energy to oxyradical metabolism, we are witnessing an exciting era in the multidisciplinary field of ageing research. The journal explores the cellular and molecular foundations of interventions that extend lifespan, such as caloric restriction. It identifies the underpinnings of manipulations that extend lifespan, shedding light on novel approaches for preventing age-related diseases. ARR publishes articles on focused topics selected from the expansive field of ageing research, with a particular emphasis on the cellular and molecular mechanisms of the aging process. This includes age-related diseases like cancer, cardiovascular disease, diabetes, and neurodegenerative disorders. The journal also covers applications of basic ageing research to lifespan extension and disease prevention, offering a comprehensive platform for advancing our understanding of this critical field.