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Meta-Analysis
. 2024 Oct;36(10):880-928.
doi: 10.1017/S1041610224000085. Epub 2024 Feb 8.

Efficacy and safety of transcranial magnetic stimulation on cognition in mild cognitive impairment, Alzheimer's disease, Alzheimer's disease-related dementias, and other cognitive disorders: a systematic review and meta-analysis

Sandeep R Pagali  1   2 , Rakesh Kumar  3 , Allison M LeMahieu  4 , Michael R Basso  5 , Bradley F Boeve  6 , Paul E Croarkin  5 , Jennifer R Geske  4 , Leslie C Hassett  7 , John Huston 3rd  8 , Simon Kung  5 , Brian N Lundstrom  6 , Ronald C Petersen  6 , Erik K St Louis  6 , Kirk M Welker  8 , Gregory A Worrell  6 , Alvaro Pascual-Leone  9   10 , Maria I Lapid  2   5
Affiliations
Meta-Analysis

Efficacy and safety of transcranial magnetic stimulation on cognition in mild cognitive impairment, Alzheimer's disease, Alzheimer's disease-related dementias, and other cognitive disorders: a systematic review and meta-analysis

Sandeep R Pagali et al. Int Psychogeriatr. 2024 Oct.

Abstract

Objective: We aim to analyze the efficacy and safety of TMS on cognition in mild cognitive impairment (MCI), Alzheimer's disease (AD), AD-related dementias, and nondementia conditions with comorbid cognitive impairment.

Design: Systematic review, Meta-Analysis.

Setting: We searched MEDLINE, Embase, Cochrane database, APA PsycINFO, Web of Science, and Scopus from January 1, 2000, to February 9, 2023.

Participants and interventions: RCTs, open-label, and case series studies reporting cognitive outcomes following TMS intervention were included.

Measurement: Cognitive and safety outcomes were measured. Cochrane Risk of Bias for RCTs and MINORS (Methodological Index for Non-Randomized Studies) criteria were used to evaluate study quality. This study was registered with PROSPERO (CRD42022326423).

Results: The systematic review included 143 studies (n = 5,800 participants) worldwide, encompassing 94 RCTs, 43 open-label prospective, 3 open-label retrospective, and 3 case series. The meta-analysis included 25 RCTs in MCI and AD. Collectively, these studies provide evidence of improved global and specific cognitive measures with TMS across diagnostic groups. Only 2 studies (among 143) reported 4 adverse events of seizures: 3 were deemed TMS unrelated and another resolved with coil repositioning. Meta-analysis showed large effect sizes on global cognition (Mini-Mental State Examination (SMD = 0.80 [0.26, 1.33], p = 0.003), Montreal Cognitive Assessment (SMD = 0.85 [0.26, 1.44], p = 0.005), Alzheimer's Disease Assessment Scale-Cognitive Subscale (SMD = -0.96 [-1.32, -0.60], p < 0.001)) in MCI and AD, although with significant heterogeneity.

Conclusion: The reviewed studies provide favorable evidence of improved cognition with TMS across all groups with cognitive impairment. TMS was safe and well tolerated with infrequent serious adverse events.

Keywords: MCI; TMS; cognition; dementia; meta-analysis; mild cognitive impairment; systematic review; transcranial magnetic stimulation.

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Figures

Figure 1.
Figure 1.. PRISMA Flow Diagram.
AD indicates Alzheimer disease; ADAS-Cog, Alzheimer’s Disease Assessment Scale–Cognitive Subscale; MCI, mild cognitive impairment; MMSE, Mini-Mental Status Examination; MoCA, Montreal Cognitive Assessment; PRISMA, Preferred Reporting Items for Systematic reviews and Meta-Analyses; RCT, randomized clinical trial; TMS, transcranial magnetic stimulation.
Figure 2.
Figure 2.. Forest Plot Analysis of Different Cognitive Outcomes. A, Mini-Mental Status Examination (MMSE). B, Montreal Cognitive Assessment (MoCA). C, Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog).
RE, random effects; rTMS, repetitive transcranial magnetic stimulation; tDCS, transcranial direct current stimulation; TMS, transcranial magnetic stimulation.
Figure 2.
Figure 2.. Forest Plot Analysis of Different Cognitive Outcomes. A, Mini-Mental Status Examination (MMSE). B, Montreal Cognitive Assessment (MoCA). C, Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog).
RE, random effects; rTMS, repetitive transcranial magnetic stimulation; tDCS, transcranial direct current stimulation; TMS, transcranial magnetic stimulation.
Figure 3.
Figure 3.. Qualitative Assessments.
MINORS indicates Methodological Index for Non-Randomized Studies; RCT, randomized clinical trial.
See this image and copyright information in PMC

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