Transcranial Magnetic Stimulation
Transcranial Magnetic Stimulation
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(rTMS组231例，对照组207例)共纳入13个随机、双盲、对照试验。随机效应分析显示，与对照组相比，rTMS刺激显著提高了MCI和早期AD患者的认知功能(平均效应大小为1.17；95%CI为0.76~1.57)。大多数rTMS参数(频率、会话数、刺激点数)的设置显著增强了整体认知功能，结果表明，以10 Hz重复频率和DLPFC为刺激点数20次的方案已经能够产生认知改善。治疗结束后，rTMS的认知功能增强可持续1个月，MCI患者可能从rTMS刺激中获益更多。这项研究为MCI和早期AD患者rTMS的认知增强提供了重要证据，并讨论了rTMS诱导认知增强的潜在机制。这些限制包括试验数量有限，样本量小，无法相对于所有研究的基线评估治疗的变化，以及刺激参数(频率、疗程数、刺激部位)的高度异质性。更多的随机对照研究需要更大的样本量和更好的设计，以确定rTMS干预AD患者认知的最佳参数。
(231 in the rTMS group and 207 in the control group) in thirteen randomized, double-blind and controlled trials were included. Random effects analysis revealed that rTMS stimulation significantly introduced cognitive benefits in patients of MCI and early AD compared with the control group (mean effect size, 1.17; 95% CI, 0.76 - 1.57). Most settings of rTMS parameters (frequency, session number, stimulation site number) significantly enhanced global cognitive function, and the results revealed that protocols with 10 Hz repetition frequency and DLPFC as the stimulation site for 20 sessions can already be able to produce cognitive improvement. The cognitive enhancement of rTMS could last for one month after the end of treatment and patients with MCI were likely to benefit more from the rTMS stimulation. This study added important evidence to the cognitive enhancement of rTMS in patients with MCI and early AD and discussed potential underlying mechanisms about the effect induced by rTMS. The limitations included a limited number of trials, small sample size, inability to assess the change of treatment relative to the baseline of all studies and high heterogeneity of stimulation parameters (frequency, session number, stimulation site). Additional randomized controlled studies are needed with larger sample sizes and better design to identify the optimal parameters of rTMS intervention on cognition of AD patients.