SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Cognitive and Behavioral Neurology
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1670778
Non-Invasive Brain Stimulation Combined with three Rehabilitation Approaches for Cognitive and Emotional Well-Being in Parkinson's Patients
Provisionally accepted
- 1Woosuk University, Wanju-gun, Republic of Korea
- 2Shanghai University of Sport, Shanghai, China
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Background: Parkinson's disease progressively impairs both motor and non-motor functions, with over 60% of patients developing cognitive decline and nearly half suffering from depression or anxiety. While dopaminergic therapies inadequately address these symptoms, traditional rehabilitation shows inconsistent results due to impaired neuroplasticity. Non-invasive brain stimulation (tDCS/rTMS) may enhance rehabilitation by modulating neural activity, but the optimal combined approaches remain unclear. This study evaluates three rehabilitation strategies paired with brain stimulation to improve cognitive and emotional outcomes in Parkinson's patients Methods: We systematically searched PubMed, Web of Science, EMBASE, Cochrane Library, and China National Knowledge Infrastructure (CNKI), ultimately including 7 randomized controlled trials (15 interventions, N=325 Parkinson's patients). Outcomes assessed cognitive function and emotional well-being measures. Using STATA 18.0, we conducted a network meta-analysis to evaluate relative intervention effects and assess consistency between direct/indirect evidence. Results visualized through network plots and ranked by SUCRA probabilities. Results: The analysis revealed that cognitive rehabilitation combined with non-invasive brain stimulation (CR) showed superior efficacy for cognitive improvement (SMD=4.88, 95% CI [-1.91, 11.67]; SUCRA=81.2), while combined motor-cognitive rehabilitation (MCR) excelled in emotional well-being (SMD=4.76, 95% CI [2.70, 6.82], p<0.00001; SUCRA=99.5). CR for cognitive benefits and MCR for emotional regulation, with CR demonstrating the most stable treatment effects. Conclusion: This study demonstrates that non-invasive brain stimulation combined with cognitive rehabilitation (CR) is the most effective approach for improving cognitive function in Parkinson's patients, while combined motor-cognitive rehabilitation (MCR) shows particular efficacy for emotional well-being. The findings support personalized intervention strategies: CR for cognitive impairment and MCR for emotional symptoms. Future research should optimize combined protocols to enhance synergistic effects while minimizing patient burden. This evidence-based recommendation provides important guidance for clinical practice in managing Parkinson's non-motor symptoms.
Keywords: non-invasive brain stimulation, Cognitive rehabilitation, Parkinson's disease, emotional well-being, Motor therapy
Received: 22 Jul 2025; Accepted: 19 Sep 2025.
Copyright: © 2025 Fan, Lin, Haojie and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lan Li, 13032425419@163.com
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