Repetitive transcranial magnetic stimulation (rTMS) fails to improve cognition in patients with parkinson's disease: a Meta-analysis of randomized controlled trials

• Published in: International journal of neuroscience Vol. 132; no. 3; pp. 269 - 282
• Main Authors: He, Pei Kun, Wang, Li Min, Chen, Jia Ning, Zhang, Yu Hu, Gao, Yu Yuan, Xu, Qi Huan, Qiu, Yi Hui, Cai, Hui Min, Li, You, Huang, Zhi Heng, Feng, Shu Jun, Zhao, Jie Hao, Ma, Gui Xian, Nie, Kun, Wang, Li Juan
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 04.03.2022
• Subjects: cognition; meta-analysis; Parkinson's disease; randomized controlled trial; repetitive transcranial magnetic stimulation; meta-analysis; cognition; Parkinson’s disease; randomized controlled trial; repetitive transcranial magnetic stimulation
• ISSN: 0020-7454; 1563-5279; 1543-5245
• DOI: 10.1080/00207454.2020.1809394

Cognitive decline is one of the greatest concerns for patients with Parkinson's disease (PD) and their care partners. Repetitive transcranial magnetic stimulation (rTMS) is a nonpharmacological treatment option used to improve cognitive function in PD, but its efficacy is unclear. We performed a meta-analysis to determine whether rTMS improves cognition in PD patients. Eligibility criteria (PICOS) were as follows: (1) 'P': The patients participating were diagnosed with idiopathic PD; (2) 'I': Intervention using rTMS; (3) 'C': Sham stimulation as control; (4) 'O': The outcome of the study included cognitive evaluations; (5) 'S': The study adopted randomized controlled design. The standardized mean difference (SMD) of change of score was applied to measure efficacy, and we used Version 2 of the Cochrane tool to assess risk of bias. Twelve studies met the inclusion criteria. Compared with sham-controlled group, the pooled result showed a non-significant short-term effect of rTMS on global cognition (SMD: −0.15, 95% CI: −0.59 to 0.29, I 2 = 36.7%), executive function (SMD: 0.03, 95% CI: −0.21 to 0.26, I 2 = 0.0%), and attention and working memory (SMD: 0.05, 95% CI: −0.25 to 0.35, I 2 = 0.0%). Long-term outcomes were either shown to be statistically nonsignificant. Based on a limited number of studies, rTMS fails to improve cognition in PD. We call for additional high-quality randomized controlled trials with adequate sample sizes to determine the efficacy of rTMS.