AUTHOR=Zhang Tianjiao , Sui Youxin , Lu Qian , Xu Xingjun , Zhu Yi , Dai Wenjun , Shen Ying , Wang Tong 

TITLE=Effects of rTMS treatment on global cognitive function in Alzheimer's disease: A systematic review and meta-analysis

JOURNAL=Frontiers in Aging Neuroscience

VOLUME=14

YEAR=2022

URL=https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2022.984708

DOI=10.3389/fnagi.2022.984708

ISSN=1663-4365

ABSTRACT=<sec><title>Background</title><p>Although repetitive transcranial magnetic stimulation (rTMS) has been extensively studied in patients with Alzheimer's disease (AD), the clinical evidence remains inconsistent. The purpose of this meta-analysis was to evaluate the effects of rTMS on global cognitive function in patients with AD.</p></sec><sec><title>Methods</title><p>An integrated literature search using 4 databases (PubMed, Web of Science, Embase, and Cochrane Library) was performed to identify English language articles published up to October 6, 2021. We pooled Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog) scores using a random-effects model <italic>via</italic> RevMan 5.4 software. We calculated estimates of mean differences (MD) with 95% confidence intervals (CI). The primary outcomes were pre-post treatment changes in global cognition as measured using MMSE and ADAS-Cog immediately after rTMS treatment, and the secondary outcome was duration of cognitive improvement (1–1.5 and ≥3 months).</p></sec><sec><title>Results</title><p>Nine studies with 361 patients were included in this meta-analysis. The results showed that rTMS significantly improved global cognitive function immediately following rTMS treatment [(MD) 1.82, 95% confidence interval (CI) 1.41–2.22, <italic>p</italic> &lt; 0.00001, MMSE; 2.72, 95% CI, 1.77–3.67, <italic>p</italic> &lt; 0.00001, ADAS-Cog], and the therapeutic effects persisted for an extended duration (2.20, 95% CI, 0.93–3.47, <italic>p</italic> =0.0007, MMSE; 1.96, 95% CI, 0.96–2.95, <italic>p</italic> = 0.0001, ADAS-Cog). Subgroup analyses showed that high frequency rTMS targeted to the left dorsolateral prefrontal cortex (DLPFC) for over 20 sessions induced the greatest cognitive improvement, with effects lasting for more than 1 month after the final treatment. There were no significant differences in dropout rate (<italic>p</italic> &gt; 0.05) or adverse effect rate (<italic>p</italic> &gt; 0.05) between the rTMS and control groups.</p></sec><sec><title>Conclusions</title><p>Repetitive TMS is a potentially effective treatment for cognitive impairment in AD that is safe and can induce long-lasting effects. Our results also showed that ADAS-cog and MMSE differed in determination of global cognitive impairment.</p></sec><sec><title>Systematic review registration</title><p><ext-link ext-link-type="uri" xlink:href="http://www.crd.york.ac.uk/PROSPERO" xmlns:xlink="http://www.w3.org/1999/xlink">http://www.crd.york.ac.uk/PROSPERO</ext-link>, PROSPERO CRD42022315545.</p></sec>