The Effect of Non-Invasive Brain Stimulation (NIBS) on Attention and Memory Function in Stroke Rehabilitation Patients: A Systematic Review and Meta-Analysis.
The Effect of Non-Invasive Brain Stimulation (NIBS) on Attention and Memory Function in Stroke Rehabilitation Patients: A Systematic Review and Meta-Analysis.
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DOI：
10.3390/diagnostics11020227
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发表时间：
2021-02-03
期刊：
影响因子：
--
通讯作者：
Burhan AM
中科院分区：
文献类型：
--
作者：
Hara T;Shanmugalingam A;McIntyre A;Burhan AM
背景资料：近年来，非侵入性脑刺激（NIBS）对脑卒中人群认知功能的治疗效果的潜力已被探索。根据刺激部位和刺激参数，存在各种NIBS方法。然而，目前尚无NIBS对卒中后认知障碍的系统性综述，重点关注刺激部位和刺激参数。本研究的目的是对NIBS治疗脑卒中后认知功能障碍的有效性和安全性进行系统评价和荟萃分析，以获得新的见解。本研究在PROSPERO系统综述数据库（CRD 42020183298）中进行了前瞻性注册。方法：检索MEDLINE、Scopus、CINAHL、Embase、PsycINFO和CENTRAL中从开始到2020年12月31日的所有英文文献。随机和前瞻性对照试验纳入分析。纳入了至少5名卒中后患者的研究，其中提供了至少5次NIBS，并使用了标准化的神经心理学认知测量。我们评估了物理治疗证据数据库（PEDro）评分系统中描述的所选研究的方法学质量。结果：共有10项研究符合合格标准。6项研究使用重复经颅磁刺激（rTMS），4项研究使用经颅直流电刺激（tDCS）。合并样本量分别为221和196名接受rTMS和tDCS的个体。8项研究将一般康复、认知训练或其他治疗与NIBS相结合。在rTMS研究中，目标症状包括整体认知（n = 4）、注意力（n = 3）、记忆（n = 4）、工作记忆（WM）（n = 3）和执行功能（n = 2）。5项研究选择左背外侧前额叶皮层（DPLFC）作为刺激靶点。一项rTMS研究选择右侧DLPFC作为抑制性刺激靶点。六项研究中有四项显示出显著改善。在tDCS研究中，目标症状包括整体认知（n = 2）、注意（n = 4）、记忆（n = 2）和WM（n = 2）。三项研究选择额区作为刺激目标。所有研究均显示出显著改善。在荟萃分析中，经颅磁刺激对注意力、记忆力、工作记忆和整体认知有显著影响。另一方面，tDCS没有显著影响。结论：在脑卒中后认知功能障碍的患者中，包括注意力，记忆力和WM，NIBS显示出有希望的积极作用。然而，这种效果是有限的，这表明需要进一步的研究，更精确的刺激部位和刺激参数。未来的研究使用先进的神经生理学和神经影像学工具，允许一个基于网络的方法来治疗脑卒中后的认知症状与NIBS是必要的。
Background: In recent years, the potential of non-invasive brain stimulation (NIBS) for therapeutic effects on cognitive functions has been explored for populations with stroke. There are various NIBS methods depending on the stimulation site and stimulation parameters. However, there is no systematic NIBS review of post-stroke cognitive impairment with a focus on stimulation sites and stimulation parameters. The purpose of this study is to conduct a systematic review and meta-analysis on effectiveness and safety of NIBS for cognitive impairment after a stroke to obtain new insights. This study was prospectively registered with the PROSPERO database of systematic reviews (CRD42020183298). Methods: All English articles from MEDLINE, Scopus, CINAHL, Embase, PsycINFO, and CENTRAL were searched from inception up to 31 December 2020. Randomized and prospective controlled trials were included for the analysis. Studies with at least five individuals post-stroke, whereby at least five sessions of NIBS were provided and using standardized neuropsychological measurement of cognition, were included. We assessed the methodological quality of selected studies as described in the Physiotherapy Evidence Database (PEDro) scoring system. Results: A total of 10 studies met eligibility criteria. Six studies used repetitive transcranial magnetic stimulation (rTMS) and four studies used transcranial direct current stimulation (tDCS). The pooled sample size was 221 and 196 individuals who received rTMS and tDCS respectively. Eight studies combined general rehabilitation, cognitive training, or additional therapy with NIBS. In rTMS studies, target symptoms included global cognition (n = 4), attention (n = 3), memory (n = 4), working memory (WM) (n = 3), and executive function (n = 2). Five studies selected the left dorsolateral prefrontal cortex (DPLFC) as the stimulation target. One rTMS study selected the right DLPFC as the inhibitory stimulation target. Four of six studies showed significant improvement. In tDCS studies, target symptoms included global cognition (n = 2), attention (n = 4), memory (n = 2) and WM (n = 2). Three studies selected the frontal area as the stimulation target. All studies showed significant improvement. In the meta-analysis, rTMS showed a significant effect on attention, memory, WM and global cognition classified by neuropsychological tests. On the other hand, tDCS had no significant effect. Conclusions: In post-stroke patients with deficits in cognitive function, including attention, memory, and WM, NIBS shows promising positive effects. However, this effect is limited, suggesting that further studies are needed with more precision in stimulation sites and stimulation parameters. Future studies using advanced neurophysiological and neuroimaging tools to allow for a network-based approach to treat cognitive symptoms post-stroke with NIBS are warranted.
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