Journal of Shanghai Jiao Tong University (Medical Science) >

2021 , Vol. 41 >Issue 7: 931 - 941

DOI: https://doi.org/10.3969/j.issn.1674-8115.2021.07.014

Evidence-based medicine

Meta-analysis of efficacy of transcranial magnetic stimulation for the treatment of cognitive function and behavioral and psychological symptoms of dementia in patients with Alzheimer′s disease

  • Yi WANG ,
  • Cheng CHENG ,
  • Hong-yan SHEN ,
  • Hong-yan GAO ,
  • Yue-ning DAI ,
  • Zheng-hui YI
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  • 1.Department of Psychiatry, Jiading Mental Health Center, Shanghai 201806, China
    2.Clinical Medicine of Traditional Chinese and Western Medicine, Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
    3.Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China

Online published: 2021-08-03

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Abstract

Objective

·To evaluate the efficacy of transcranial magnetic stimulation (TMS) on cognitive function and behavioral and psychological of dementia (BPSD) in Alzheimer′s disease (AD) patients.

Methods

·Nine databases including China National Knowledge Infrastructure (CNKI), WanFang, VIP, Chinese Biomedical Literature Database (CBM), PubMed, Embase, the Cochrane Library and Chinese and American Clinical Trial Center were searched before November 2, 2019. English was searched with the topics of “Alzheimer′s disease” “transcranial magnetic stimulation” and “randomize controlled trial”, and free words were retrieved. Chinese was searched with the topics of “阿尔茨海默病”“经颅磁刺激”“随机对照试验”. According to the pre-established inclusion and exclusion criteria, the literatures were screened. RevMan 5.3 software was used. The standardized mean difference (SMD) was used as the effect value, and 95% confidence interval (CI) was used for interval estimation. Gradeprofile 3.2.2 software was used to evaluate the quality of evidence.

Results

·A total of 23 articles were included. In improving cognitive function, the evaluation results of AD Assessment Scale-Cognitive suggest that SMD of high frequency TMS group was -0.64 (95%CI -0.89 ? -0.40, P=0.000), SMD of low frequency TMS group was -0.58 (95%CI -1.12 ? -0.05, P=0.030). The Grade of evidence quality was very lower and lower respectively. When using Mini-Mental State Examination to evaluate cognitive function, it was divided into three subgroups according to TMS frequency (high or low, value) and treatment times. The results showed that SMD in high frequency TMS group was 1.30 (95% CI 0.76?1.85, P = 0.000), but no significant difference was found in low frequency group. The Grade of evidence quality were both very lower. In 5 Hz group, SMD was 3.99 (95%CI 0.81~7.16, P=0.010) and the Grade evidence quality grade was very low. In the group of treatment times >40 and ≤60, SMD was 3.28 (95%CI 1.67?4.90, P=0.000) and the Grade evidence quality grade was very low. In the aspect of improving BPSD, the Neuropsychiatric Inventory was used to evaluate, and the result was no statistically significant. The Grade evidence quality grade was very low. Behavioral Pathology in Alzheimer′s Disease Scale showed that SMD of high frequency group was -0.83 (95%CI -1.06? -0.60, P=0.000), and there was no significance in low frequency group.The Grade evidence quality grade were low and very low respectively.

Conclusion

·TMS could improve the cognitive function of patients with AD, and high frequency was better than low frequency. The quality of evidence was lower. Whether the BPSD of AD patients were effective needs further research. In the future, more high-quality clinical multicenter randomized controlled trails should be included to study the efficacy and safety of TMS in the treatment of AD, so as to provide guidance for clinical practice.

Key words： Alzheimer′s disease (AD); transcranial magnetic stimulation (TMS); cognitive function; behavioral and psychological symptoms of dementia (BPSD); meta-analysis; randomized controlled trial (RCT)

Cite this article

Yi WANG , Cheng CHENG , Hong-yan SHEN , Hong-yan GAO , Yue-ning DAI , Zheng-hui YI . Meta-analysis of efficacy of transcranial magnetic stimulation for the treatment of cognitive function and behavioral and psychological symptoms of dementia in patients with Alzheimer′s disease[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2021 , 41(7) : 931 -941 . DOI: 10.3969/j.issn.1674-8115.2021.07.014

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