关键词: 帕金森病, 非侵入性脑刺激, 经颅直流电刺激, 重复经颅磁刺激, 高频重复经颅磁刺激, 高低频交互重复经颅磁刺激, 认知障碍, 网状Meta分析

Abstract: OBJECTIVE: Cognitive impairment is one of the most common non-motor symptoms of Parkinson's disease, which seriously affects patients’ quality of life. Non-invasive brain stimulation, as a common non-pharmacological treatment, has good efficacy in improving cognitive impairment after Parkinson’s disease, but how to choose the optimal stimulation modality of non-invasive brain stimulation in clinical practice is still unclear. This study assessed the effects of different stimulation modalities of non-invasive brain stimulation on cognitive function in patients with Parkinson’s disease by means of the network Meta-analysis, which provides an evidence-based basis for the selection of non-invasive brain stimulation modalities in the clinic.
METHODS: PubMed, EMbase, Web of Science, Cochrane Library, CNKI, CBM, and WanFang databases were searched for randomized controlled trials on the effects of non-invasive brain stimulation interventions on cognitive function in patients with Parkinson’s disease from the inception to August 2024. The control group was treated with conventional therapy (rehabilitation training and conventional medication) or sham stimulation, and the experimental group was treated with non-invasive brain stimulation based on the treatment in the control group. The Cochrane Risk of Bias Assessment Tool for Randomized Controlled Trials RoB 2 was used to evaluate the quality of the included studies. Literature screening and data extraction were performed independently by two researchers and the risk of bias for the included studies was evaluated. Traditional Meta-analysis and network Meta-analysis of short-term cognitive functioning scale scores and long-term cognitive functioning scale scores were performed using RevMan 5.4 and Stata 16.0 software to draw network relationship, diagrams league table and cumulative probability ranking tables. GRADE was used to rate the level of evidence for the outcome indicators.
RESULTS: (1) A total of 31 randomized controlled trials were included, of which 8 studies were rated as low-risk, 23 studies were rated as medium-risk, and there were no high-risk studies, comprising 1 670 subjects and involving different stimulation modalities for 14 types of non-invasive brain stimulation. (2) Network Meta-analysis showed that compared with conventional treatment, high-frequency repetitive transcranial magnetic stimulation of the first motor cortex (standardized mean difference [SMD]=0.73, 95% confidence interval [CI]=0.14-1.32, P < 0.05, the surface under the cumulative ranking curve [SUCRA]=66.2%) was the most effective in improving short-term cognitive functioning in Parkinson’s patients, followed by transcranial direct current stimulation of the dorsolateral prefrontal cortex (SMD=0.56, 95% CI=0.14-0.98, P < 0.05, SUCRA=54.4%) and high-frequency repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex (SMD=0.52, 95% CI=0.11-0.93, P < 0.05, SUCRA=51.4%); and in terms of improvement of long-term cognitive functioning in patients with Parkinson’s disease, high-frequency repetitive transcranial magnetic stimulation of the first motor cortex (SMD=1.17, 95% CI=0.48-1.85, P < 0.05, SUCRA=91.2%) was the most effective.
CONCLUSION: Low-level intensity clinical evidence suggests that high-frequency repetitive transcranial magnetic stimulation of the first motor cortex is the most effective in improving short-term cognitive function in patients with Parkinson’s disease, followed by transcranial direct current stimulation of the dorsolateral prefrontal cortex and high-frequency repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex. Also high-frequency repetitive transcranial magnetic stimulation of the first motor cortex is the best stimulation modality in improving long-term cognitive function in patients with Parkinson’s disease. 

Key words: Parkinson’s disease, non-invasive brain stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, high-frequency repetitive transcranial magnetic stimulation, high and low frequency reciprocal repetitive transcranial magnetic stimulation, cognitive impairment, network Meta-analysis