{"title":"Comparative Efficacy of iTBS and rTMS in Treating Post-Stroke Cognitive Impairment: A Double-Blind Randomized Controlled Trial.","authors":"Menglin Han, Yulan Gao, Jinyan He, Longting Hu, Zhiqiang Wang, Zhuoming Chen, Kangling Wang","doi":"10.1177/15459683261426347","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To compare the therapeutic effect of intermittent theta burst stimulation (iTBS) and repetitive transcranial magnetic stimulation (rTMS) on cognitive function in patients with post-stroke cognitive impairment (PSCI) and investigate underlying neuroelectrophysiological mechanisms using microstate analysis.</p><p><strong>Methods: </strong>In this randomized, double-blind, sham-controlled trial, 45 patients with PSCI were assigned 2:2:1 to iTBS, rTMS, and sham groups, with stimulation targeting the left dorsolateral prefrontal cortex. All participants also received therapist-delivered cognitive training in addition to stimulation. Outcomes were evaluated before (T0) and 10 days after (T1). The primary outcome measure was Montreal Cognitive Assessment (MoCA) score. Secondary outcomes were auditory verbal learning test, Wechsler Adult Intelligence Scale-Ⅲ digit symbol coding test and digit span test scores as well as microstate indices.</p><p><strong>Results: </strong>ΔMoCA(T1-T0) scores were significantly improved in both the iTBS (median [interquartile range]: 2.00 [1.00, 4.00]) and rTMS groups (2.00 [1.00, 3.00]) compared with sham group (<i>P</i> < .05). There was no significant difference in ΔMoCA between the 2 active protocols. Significant within-group improvements in memory and working memory were observed in the iTBS group (<i>P</i> < .05). Both iTBS and rTMS group showed significantly increased microstate C parameters between T0 and T1 (<i>P</i> < .05). Furthermore, the transition probabilities in the iTBS group showed more diversity between microstates, while the other groups showed no significant transformation.</p><p><strong>Conclusion: </strong>iTBS and 5-Hz rTMS were effective in improving overall cognitive ability in PSCI, and iTBS may represent a practical, time-efficient alternative to 5-Hz rTMS. EEG microstate suggested distinct modulation patterns, serving as a useful exploratory tool.Clinical Trial Registry Name:Effect of different transcranial magnetic stimulation protocols on cognitive function in patients with post-stroke cognitive impairment.</p><p><strong>Clinical trial registration-url: </strong>https://www.chictr.org.cn/Clinical Trial Registration Number:ChiCTR2200064233.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"495-507"},"PeriodicalIF":3.7000,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurorehabilitation and neural repair","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/15459683261426347","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/3/18 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: To compare the therapeutic effect of intermittent theta burst stimulation (iTBS) and repetitive transcranial magnetic stimulation (rTMS) on cognitive function in patients with post-stroke cognitive impairment (PSCI) and investigate underlying neuroelectrophysiological mechanisms using microstate analysis.
Methods: In this randomized, double-blind, sham-controlled trial, 45 patients with PSCI were assigned 2:2:1 to iTBS, rTMS, and sham groups, with stimulation targeting the left dorsolateral prefrontal cortex. All participants also received therapist-delivered cognitive training in addition to stimulation. Outcomes were evaluated before (T0) and 10 days after (T1). The primary outcome measure was Montreal Cognitive Assessment (MoCA) score. Secondary outcomes were auditory verbal learning test, Wechsler Adult Intelligence Scale-Ⅲ digit symbol coding test and digit span test scores as well as microstate indices.
Results: ΔMoCA(T1-T0) scores were significantly improved in both the iTBS (median [interquartile range]: 2.00 [1.00, 4.00]) and rTMS groups (2.00 [1.00, 3.00]) compared with sham group (P < .05). There was no significant difference in ΔMoCA between the 2 active protocols. Significant within-group improvements in memory and working memory were observed in the iTBS group (P < .05). Both iTBS and rTMS group showed significantly increased microstate C parameters between T0 and T1 (P < .05). Furthermore, the transition probabilities in the iTBS group showed more diversity between microstates, while the other groups showed no significant transformation.
Conclusion: iTBS and 5-Hz rTMS were effective in improving overall cognitive ability in PSCI, and iTBS may represent a practical, time-efficient alternative to 5-Hz rTMS. EEG microstate suggested distinct modulation patterns, serving as a useful exploratory tool.Clinical Trial Registry Name:Effect of different transcranial magnetic stimulation protocols on cognitive function in patients with post-stroke cognitive impairment.
目的：比较间歇性θ波爆发刺激（iTBS）和重复经颅磁刺激（rTMS）对脑卒中后认知功能障碍（PSCI）患者认知功能的治疗效果，并利用微状态分析探讨其神经电生理机制。方法：在这项随机、双盲、假对照试验中，45例PSCI患者被按2:2:1分为iTBS、rTMS和假手术组，刺激目标为左背外侧前额皮质。除刺激外，所有参与者还接受了治疗师提供的认知训练。分别在治疗前（T0）和治疗后10天（T1）评价治疗效果。主要结局指标为蒙特利尔认知评估（MoCA）评分。次要指标为听觉言语学习测试、韦氏成人智力量表-Ⅲ数字符号编码测试、数字广度测试成绩及微观状态指标。结果：与假手术组相比，iTBS组（中位数[四分位数范围]:2.00[1.00,4.00]）和rTMS组（2.00[1.00,3.00]）的ΔMoCA（T1-T0）评分均有显著提高（P P P P）。结论：iTBS和5 hz rTMS可有效改善PSCI患者的整体认知能力，iTBS可能是5 hz rTMS的一种实用、高效的替代方案。脑电微态显示出不同的调制模式，可作为一种有用的探索工具。临床试验注册名称：不同经颅磁刺激方案对脑卒中后认知功能障碍患者认知功能的影响。临床试验注册-网址：https://www.chictr.org.cn/Clinical试验注册号：ChiCTR2200064233。
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