The role of noninvasive brain stimulation for behavioral and psychological symptoms of dementia: a systematic review and meta-analysis
This meta-analysis aimed at evaluating and comparing the efficacy of noninvasive brain stimulation (NIBS) techniques on the behavioral and psychological symptoms of dementia (BPSD).
An exhaustive literature retrieval was performed on PubMed, Embase, Cochrane Library, and Web of Science until October 2019. The primary outcome was the relative changes in BPSD severity scores immediately after NIBS and at the last follow-up visit. Subgroup analyses were conducted to compare the efficacy of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). Changes in the severity scores after NIBS were also analyzed with restriction to patients with Alzheimer’s disease (AD).
Ten studies with 324 patients were included, out of which 7 studies involved patients with AD. The analysis results indicated that NIBS significantly improved the BPSD outcome immediately after stimulation (SMD, 0.31; 95% CI, 0.10–0.52; P = 0.005), but not at the last follow-up visit (0.15; − 0.11–0.41; 0.25). Our subgroup analyses suggested that the favorable effects of rTMS remained significant at the last follow-up visit (0.57; 0.18–0.96; 0.004). This discrepancy maybe caused by the continuously insignificant outcomes of tDCS on the whole data. The results for AD patients immediately after stimulation (0.37; 0.12–0.61; 0.003) and at the last follow-up visit (0.29; − 0.19–0.76; 0.24) were both largely similar to those in the whole patient group with dementia.
rTMS, rather than tDCS, was capable of persistently improving the BPSD at an early stage after treatment. More trials are warranted to confirm our results before the establishment of final conclusions.
KeywordsBehavioral and psychological symptoms Dementia Transcranial direct current stimulation Transcranial magnetic stimulation Randomized controlled trial Meta-analysis
This study was supported by the National Natural Science Foundation of China (grant no. 8187052509) and National Clinical Research Center for Geriatric Diseases (grant no. NCRCG-PLAGH-2018006).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All studies in this review have been approved by the local ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
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