Effects and safety of repetitive transcranial magnetic stimulation on cognitive outcomes in mild cognitive impairment: a systematic review and meta-analysis.
完整摘要 · 中文译文
背景：重复经颅磁刺激（rTMS）是一种非侵入性神经调控技术，近年来作为轻度认知障碍（MCI）的潜在治疗方法受到越来越多研究。然而，由于各研究结果不一致，其临床疗效仍不确定。 方法：对比较活性rTMS与假刺激或匹配对照干预的随机对照试验进行了系统综述和荟萃分析。检索了电子数据库自建库以来的文献。纳入的研究包括MCI患者，并使用经验证的量表报告认知结局，包括蒙特利尔认知评估（MoCA）、简易精神状态检查（MMSE）或Rivermead行为记忆测验（RBMT）。 结果：共纳入14项研究，贡献15个数据集。与假刺激或对照干预相比，rTMS与干预后MoCA、MMSE和RBMT评分较高相关。对于主要结局MoCA，合并效应估计显著，但伴随较大的研究间异质性（Hedges' g = 1.46，95% CI 0.97至1.94；p < 0.001；I2 = 86.0%）。探索性亚组分析显示，按刺激频率（p = 0.021）和刺激部位（p < 0.001）分组的亚组间差异显著，而按偏倚风险分组的差异无统计学意义（p = 0.114）。在报告定量安全性结局的10个数据集中，与假刺激相比未观察到不良事件显著增加（RR = 1.25，95% CI 0.76至2.04；p = 0.374）。 . 结论：rTMS可能改善轻度认知障碍（MCI）患者的认知测试表现。然而，研究间存在显著异质性，限制了估计治疗效应的精确性和可推广性。尽管探索性亚组分析提示效应可能随刺激频率和部位而变化，但这些发现尚不能确定明确的效应修饰因素或最佳刺激参数。仍需进一步开展设计良好、把握度充分、采用严格盲法、标准化方案并以具有临床意义的结局指标进行评估的试验，以明确rTMS在MCI中效应的幅度及临床相关性。
完整摘要 · 英文原文
BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique that has been increasingly investigated as a potential treatment for mild cognitive impairment (MCI). However, its clinical efficacy remains uncertain due to heterogeneous findings across studies. METHODS: A systematic review and meta-analysis of randomized controlled trials comparing active rTMS with sham stimulation or matched control interventions was conducted. Electronic databases were searched from inception. Eligible studies included patients with MCI and reported cognitive outcomes using validated scales, including the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), or Rivermead Behavioral Memory Test (RBMT). RESULTS: Fourteen studies contributing 15 datasets were included. Compared with sham or control interventions, rTMS was associated with higher post-intervention scores on the MoCA, MMSE, and RBMT. For the primary MoCA outcome, the pooled effect estimate was significant but accompanied by substantial between-study heterogeneity (Hedges' g = 1.46, 95% CI 0.97 to 1.94; p < 0.001; I2 = 86.0%). Exploratory subgroup analyses showed significant between-subgroup differences according to stimulation frequency (p = 0.021) and stimulation site (p < 0.001), whereas the difference according to risk of bias was not statistically significant (p = 0.114). Among the 10 datasets reporting quantitative safety outcomes, no significant increase in adverse events was observed compared with sham stimulation (RR = 1.25, 95% CI 0.76 to 2.04; p = 0.374). CONCLUSION: rTMS may improve cognitive test performance in patients with MCI. However, substantial between-study heterogeneity limits the precision and generalizability of the estimated treatment effect. Although exploratory subgroup analyses suggested variation according to stimulation frequency and site, these findings do not establish definitive effect modifiers or optimal stimulation parameters. Further well-designed, adequately powered trials with rigorous blinding, standardized protocols, and clinically meaningful outcomes are needed to clarify the magnitude and clinical relevance of rTMS effects in MCI.
摘要 待译
BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique that has been increasingly investigated as a potential treatment for mild cognitive impairment (MCI). However, its clinical efficacy remains uncertain due to heterogeneous findings across studies. METHODS: A systematic review and meta-analysis of randomized controlled trials comparing active rTMS with sham stimulation or matched control interventions was conducted. Electronic databases were searched from inception.…