Impact of repetitive transcranial magnetic stimulation on cognitive impairment in stroke patients: A meta-analysis of randomized controlled trials

OBJECTIVE: To evaluate the impact of repetitive transcranial magnetic stimulation (rTMS) on cognitive impairment in stroke patients using meta-analysis. METHODS: Electronic databases (PubMed, Web of Science, Cochrane Library, and Embase) were systematically searched up to October 20, 2024. Randomized controlled trials assessing the effect of rTMS on cognitive impairment in stroke patients were included. Pooled effect sizes were calculated using standardized mean differences (SMD) or mean differences (MD) based on fixed or random effects models. RESULTS: Fourteen studies involving 597 stroke patients were included in this meta-analysis. The results showed that rTMS significantly improved global cognitive function in stroke patients (SMD: 0.54; 95 % CI: 0.28, 0.79), particularly with high-intensity rTMS (SMD: 0.41; 95 % CI: 0.07, 0.76) and intermittent theta-burst stimulation (iTBS) (SMD: 0.94; 95 % CI: 0.62, 1.27). In terms of different rating scales, rTMS significantly increased scores on the Modified Barthel Index (MBI) (MD: 10.54; 95 % CI: 4.85, 16.23) and the Montreal Cognitive Assessment (MoCA) (MD: 1.96; 95 % CI: 0.91, 3.01), while the effects on the Mini-Mental State Examination (MMSE), Rivermead Behavioral Memory Test (RBMT), and Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) were not statistically significant. CONCLUSION: This meta-analysis confirms that rTMS can effectively improve cognitive function in stroke patients. However, due to the limited number of studies included, further high-quality research is needed to substantiate our findings.