The role of repetitive transcranial magnetic stimulation in the treatment of cognitive impairment in stroke patients: A systematic review and meta-analysis

Stroke is a global health problem, and survivors of a stroke often suffer from cognitive impairment, which has an essential impact on the rehabilitation of various functions. Repetitive Transcranial Magnetic Stimulation (rTMS) has been widely used in the rehabilitation treatment of stroke patients. There are many investigations into how rTMS impacts motor dysfunction, speech dysfunction and swallowing dysfunction after stroke, but the analysis of rehabilitation effect on stroke patients with cognitive dysfunction is lacking. The purpose of this study was to analyze the effect of different rTMS related therapies on cognitive impairment and to evaluate its clinical effect on cognitive rehabilitation after stroke. Four databases including PubMed, EMBASE, MEDLINE and the Cochrane Library, were searched and a total of 2754 papers were collected. Two reviewers independently completed a review of all papers' titles and abstracts, screened out the documents that met the criteria, and carried out data extraction, quality assessment, and data analysis. A total of six studies with 197 patients were included. Three studies used the Mini-Mental Status Examination (MMSE) scale to evaluate the cognitive function with a mean effect size of 1.89 (95% CI = −3.08–6.86). Two studies used the Loewenstein Occupational Therapy of Cognitive Assessment (LOTCA) scale with the mean effect size of 1.64 (95% CI = −7.65–10.93). These studies were evaluated separately. Our article provides that rTMS has a positive effect on improving the cognitive ability of stroke patients, but the evidence is still limited, and further large-scale studies are needed to explore the optimal stimulus parameters.