Effect of transcranial direct current stimulation combined with cognitive rehabilitation on cognitive function and activities of daily living in patients with post-stroke cognitive impairment: a systematic review and meta-analysis

Luo, N.; Zhao, B.; Wang, H.; Wu, J.; Luo, Y.; 1, Chunlan Xu 1 Man Yuan 1; Yuan, M.; 1C. Xu,

Abstract:

Objective: the incidence of post-stroke cognitive impairment (PSCI) has increased alongside the rising prevalence of stroke, making it one of the most serious and prevalent complications among stroke survivors. Growing interest has emerged in whether combined or multi-modal therapies can enhance outcomes through additive or synergistic effects, leading more researchers to investigate the efficacy of transcranial direct current stimulation (tDCS) combined with cognitive rehabilitation (CR) in this population. This study aims to systematically review and meta-analyze the effects of tDCS combined with CR on cognitive function and activities of daily living (ADL) in individuals with PSCI. Methods: PubMed, Web of Science, Cochrane Library, Embase and China National Knowledge Infrastructure (CNKI) were systematically searched for articles published from inception of the databases through June 2024. Two independent authors screened studies and extracted data. The methodological quality of the included randomized controlled trials (RCTs) was evaluated with the Cochrane Risk of Bias Tool. Meta-analyses were performed using R statistical software (version 4.1.2). Results: a total of 663 participants across 11 RCTs published between 2013 and 2024 were included. The meta-analysis results indicated that tDCS combined with CR significantly improved cognitive function and ADL among PSCI patients compared to the control group, as evidenced by the Montreal Cognitive Assessment test (MoCA) (MD = 3.03, 95% confidence interval = 2.07 ~ 3.99, p < 0.0001), Mini-Mental State Examination (MMSE) (MD = 1.73, 95% confidence interval = −0.05 ~ 3.52, p < 0.05), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) (MD = 11.98, 95% confidence interval = 10.02 ~ 13.93, p < 0.0001), Activity of Daily Living Scale (ADLs) (MD = 2.54, 95% confidence interval = 0.76 ~ 4.31, p < 0.05), and Modified Barthel Index (MBI) (MD = 5.23, 95% confidence interval = 1.82 ~ 8.64, p < 0.01). Subgroup analysis results revealed that tDCS combined with computer-assisted cognitive rehabilitation (CACR) had a greater positive impact on ADL. Conclusion: tDCS combined with CR significantly improves cognitive function and ADL among individuals with PSCI. Compared with conventional cognitive rehabilitation, the computer-assisted approach demonstrates greater effectiveness in improving ADL among PSCI patients.

Patologie/Applicazioni:

• Riabilitazione cognitiva
• Stimolazione elettrica transcranica (TES)
• Stroke

Anno:

2025

Tipo di pubblicazione:

Articolo

Parola chiave:

post-stroke; ictus; riabilitazione cognitiva; tDCS

Testata scientifica:

Frontiers

Mese:

06

Nota:

Questa metanalisi ha valutato l'efficacia della stimolazione transcranica a corrente diretta (tDCS) combinata con la riabilitazione cognitiva (CR) nel trattamento del deterioramento cognitivo post-ictus (PSCI), includendo 11 trial randomizzati controllati per un totale di 663 pazienti. I risultati mostrano che l’intervento combinato ha determinato un miglioramento statisticamente significativo della funzione cognitiva (MoCA: MD = 3.03; MMSE: MD = 1.73; LOTCA: MD = 11.98) e delle attività della vita quotidiana (ADLs: MD = 2.54; MBI: MD = 5.23), rispetto ai controlli. L’analisi dei sottogruppi ha evidenziato una superiorità della riabilitazione cognitiva assistita da computer (CACR) rispetto alla CR tradizionale, soprattutto nel miglioramento dell’ADL. La tollerabilità è risultata buona, con solo effetti avversi lievi e transitori. Questi dati confermano che l’integrazione di tDCS e CR rappresenta un approccio riabilitativo efficace e sicuro per migliorare la funzionalità cognitiva e quotidiana nei pazienti con PSCI.

DOI:

10.3389/fneur.2025.1523001