High-Frequency Repetitive Transcranial Magnetic Stimulation (HF-rTMS) on Overall Cognition in patients with Post-Stroke Cognitive Impairment: A Systematic Review and Meta-analysis

Abstract Objective To comprehensively assess the recovery effects of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) in patients with post-stroke cognitive impairment (PSCI). Methods Six English and four Chinese databases were searched for relevant studies published up to January 2022. Randomized controlled trials (RCTs) of patients with PSCI treated with HF-rTMS were included. Included studies were assessed for the risk of bias through the Cochrane Intervention Systematic Review Manual 5.1.0. The meta-analysis was performed using RevMan 5.4 software. The PRISMA 2020 guidelines were followed. Results Sixty-one RCTs (4012 patients) were included. Montreal cognitive assessment (MoCA) score, mini-mental state examination (MMSE) score, event-related potential (P300) amplitude, Loewenstein occupational therapy cognitive assessment (LOTCA) score, and total effective rate of cognitive function were higher in the HF-rTMS group than in the control group at the end of the treatment period, and scores of Alzheimer's disease assessment scale-cognitive subscale (ADAS-Cog) and P300 latency were lower in the HF-rTMS group than in the control group. Fifty studies had selected the dorsolateral prefrontal cortex (DLPFC) as the stimulation site for HF-rTMS. Conclusion Compared to non-rTMS or sham rTMS, HF-rTMS not only improves the overall cognitive function of PSCI patients but also has better rehabilitation results.