Effects of multi-site non-invasive brain stimulation on cognitive impairment after stroke: a systematic review and meta-analysis

Heling Wang¹Di Zhang¹Xu Wang¹Qixin Ding¹Shenhong Ma¹Qiaohua Han²Yuefang Li²Tianshu Li³Ying Li⁴Wanyue Li^4*Weisheng Zhuang^4*

• ¹School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan Province, China
• ²School of Clinical Medicine, Henan University, Zhengzhou, Henan Province, China
• ³Zhengzhou First People's Hospital, Zhengzhou, Henan Province, China
• ⁴Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, Hunan Province, China

Objective: PSCI is one of the core symptoms following a stroke, which severely affects the prognosis of patients. This systematic review and meta-analysis aim to explore the effectiveness and safety of MS-NIBS in enhancing the cognitive function of PSCI patients.A comprehensive search was conducted in multiple databases, including MEDLINE (PubMed), Embase, Web of Science, CNKI, Wanfang Data, VIP Database for Chinese Technical Periodicals, and CBM. The inclusion criteria for this meta analysis were RCTs of MS-NIBS for PSCI. The primary outcome measure was the change in the global cognitive scale, while the secondary outcomes focused on improvements in attention, memory, visuospatial perception, and activities of daily living. The Cochrane Risk of Bias Tool was used to assess the quality of each eligible study. Meta-analysis and bias analysis were performed using RevMan (Version 5.3).Results: The findings from the primary outcomes revealed that the MS-NIBS group had significantly higher scores on the MOCA of the cognitive composite scale (MD= 1.84, 95% CI= 1.21 -2.48, p < 0.00001) compared to the SS-NIBS group.As for the secondary outcome measures, as shown by the Digit Span Test (DST) forward recall (MD = 0.94, 95% CI = -1.11-2.98, p = 0.37), DST backward recall (MD = 0.03, 95% CI = -0.24-0.29, p = 0.85, ), Clock Drawing Test (CDT) (MD = 1.65, 95% CI = 0.77 -2.53, p = 0.0003), Trail Making Test (TMT) (MD = 4.2, 95% CI = 2.71 -5.69, p < 0.00001), and Modified Barthel Index (MBI) for activities of daily living assessment (MD = 3.71, 95% CI = -4.77 -12.20, p = 0.39), the MS-NIBS group showed improvements in visuospatial and trailmaking test abilities. Subgroup analysis of the main outcome demonstrated that MS-TMS (MD = 2.1, 95% CI = 1.38 -2.81, p < 0.00001) and the combined treatment of TMS and tDCS (MD = 1.91, 95% CI = 0.81 -3.01, p = 0.0007) exhibited superior efficacy compared to SS-NIBS.This meta-analysis provides evidence supporting that MS-NIBS, as an emerging neuromodulatory tool, is superior to SS-NIBS in improving the overall cognitive abilities of stroke patients.