经颅直流电刺激对帕金森病患者认知功能和生活质量影响的Meta分析

doi:10.3969/j.issn.1006-9771.2024.02.007

Abstract

Abstract:

Objective To evaluate the effect of transcranial direct current stimulation (tDCS) on the cognitive function and quality of life in patients with Parkinson's disease.
Methods Randomized controlled trials (RCTs) on tDCS for Parkinson's disease were searched in PubMed, Web of Science, Embase, Cochrane Library, CNKI, CBM, VIP and Wanfang Data from the inception to September, 2023. Control group was administered standard Parkinson's medications or placebo, physical therapy, and cognitive rehabilitation, while treatment group received tDCS additionally. The quality of the researches was evaluated using the Cochrane Risk of Bias Tool. Data synthesis and analysis were performed using RevMan 5.4 and Stata 17.0, with heterogeneity and sensitivity analyses.
Results Eight articles were included. tDCS significantly improved the scores of Montreal Cognitive Assessment (MD = 2.00, 95%CI 1.13 to 2.87, P < 0.001). However, there was no significant difference in the scores of Parkinson's Disease Questionnaire (MD = 0.73, 95%CI -5.78 to 7.23, P = 0.830), Beck Depression Inventory-Ⅱ(MD = -0.77, 95%CI -7.14 to 5.60, P = 0.810), and Unified Parkinson Disease Rating Scale-Ⅲ (MD = 1.60, 95%CI -0.77 to 3.97, P = 0.190).
Conclusion tDCS may improve cognitive function of patients with Parkinson's disease.

Key words: Parkinson's disease, cognitive impairment, transcranial direct current stimulation, meta-analysis

CLC Number:

R742.5

WANG Mingchen, ZHANG Wenyu, ZHANG Xianzuo, ZANG Wanli. Effect of transcranial direct current stimulation on cognitive function and quality of life in patients with Parkinson's disease: a meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 183-188.

Figures/Tables 5

Figure 1

Figure 2

Table 1

Characteristics of included literatures"

纳入文献	国家	n (C/T)	平均年龄 (C/T)/岁	平均病程 (C/T)	干预措施	干预方案	刺激靶点	刺激部位	结局指标
纳入文献	国家	n (C/T)	平均年龄 (C/T)/岁	平均病程 (C/T)	干预措施	干预方案	刺激靶点	刺激部位	认知功能	生活质量
Manenti等^[19](2016)	意大利	10/10	(69.10±5.60)/ (69.00±9.10)	(7.80±4.20)年/ (7.10±3.60)年	C：①② T：②+tDCS(2 mA)	每次25 min，每天1次，每周5 d，共2周	左侧DLPFC	阳极F3/F4 阴极对侧眼眶上区	-	PDQ-39 BDI-Ⅱ UPDRS-Ⅲ
孙莉等^[22](2020)	中国	11/11	(65.00±12.67)/ (62.00±14.73)	(7.60±3.20)年/ (8.20±3.80)年	C：①③④ T：③④+tDCS (2 mA)	每次40 min，每天1次，每周5 d，共4周	左侧DLPFC	阳极F3/F4 阴极对侧眼眶上部	MoCA	-
朱胜巍^[23](2020)	中国	35/35	(77.11±3.25)/ (77.06±3.23)	(3.95±2.17)年/ (3.62±2.15)年	C：③ T：③+tDCS(2 mA)	每次20 min，每周2~3次，共2个月	左侧DLPFC	阳极F3 阴极右侧眼眶上方	MoCA	-
李学等^[24](2018)	中国	28/28	(64.39±5.50)/ (64.32±5.59)	(1.28±0.56)年/ (1.19±0.57)年	C：① T：tDCS(2 mA)	每次20 min，每天1次，共8周	初级运动皮质(M1)	阳极Cz 阴极双侧眼眶上缘连线中点	MoCA	-
王广君等^[25](2016)	中国	20/20	(62.00±2.30)/ (61.00±2.10)	-	C：③⑤ T：③⑤+tDCS (1 mA)	每次10 min，每天1次，共10 d	左侧DLPFC	阳极F3 阴极对侧眉弓上缘	MoCA	-
胡喜莲等^[26](2021)	中国	49/49	(63.68±5.22)/ (64.23±4.78)	(32.32±12.40)个月/(33.02±10.65)个月	C：③⑤ T：③⑤+tDCS (2 mA)	每次25 min，每2周1次，共12周	左侧或右侧DLPFC	阳极F3/F4 阴极对侧眶上方	MoCA	-
Lawrence等^[27](2018)	澳大利亚	7/7	(72.29±6.21)/ (72.00±6.45)	(5.36±4.14)年/ (5.50±5.66)年	C：①③ T：tDCS (1.5 mA)	每次20 min，每天1次，每周1 d，共1个月	左侧DLPFC	阳极F3 阴极左眼上方	-	PDQ-39
Manenti等^[28](2018)	意大利	11/11	(63.80±7.100)/ (65.50±6.40)	(7.60±3.4)年/ (6.20±3.90)年	C：①③④ T：④+tDCS (2 mA)	每次25 min，每天1次，每周7 d，共2周	左侧DLPFC	阳极F3以上阴极右侧眶上区	-	PDQ-39 BDI-Ⅱ UPDRS-Ⅲ

Table 1

Table 2

Table 3

References 37

[1]	YE H, ROBAK L A, YU M, et al. Genetics and pathogenesis of Parkinson's syndrome[J]. Annu Rev Pathol, 2023, 18: 95-121. doi: 10.1146/pathmechdis.2023.18.issue-1
[2]	AARSLAND D, BATZU L, HALLIDAY G M, et al. Parkinson disease-associated cognitive impairment[J]. Nat Rev Dis Primers, 2021, 7(1): 47. doi: 10.1038/s41572-021-00280-3 pmid: 34210995
[3]	EL GANAINY S O, CIJSOUW T, ALI M A, et al. Stereotaxic-assisted gene therapy in Alzheimer's and Parkinson's diseases: therapeutic potentials and clinical frontiers[J]. Expert Rev Neurother, 2022, 22(4): 319-335. doi: 10.1080/14737175.2022.2056446
[4]	ARMSTRONG M J, OKUN M S. Diagnosis and treatment of Parkinson disease: a review[J]. JAMA, 2020, 323(6): 548-560. doi: 10.1001/jama.2019.22360 pmid: 32044947
[5]	MIYASAKI J M, KLUGER B. Palliative care for Parkinson's disease: has the time come?[J]. Curr Neurol Neurosci Rep, 2015, 15(5): 26. doi: 10.1007/s11910-015-0542-4
[6]	PERUZZOTTI-JAMETTI L, BACIGALUPPI M, SANDRONE S, et al. Emerging subspecialties in neurology: transcranial stimulation[J]. Neurology, 2013, 80(4): e33-e35.
[7]	AARSLAND D, ANDERSEN K, LARSEN J P, et al. Risk of dementia in Parkinson's disease: a community-based, prospective study[J]. Neurology, 2001, 56(6): 730-736. doi: 10.1212/wnl.56.6.730 pmid: 11274306
[8]	LEFAUCHEUR J P, ANTAL A, AYACHE S S, et al. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS)[J]. Clin Neurophysiol, 2017, 128(1): 56-92. doi: 10.1016/j.clinph.2016.10.087
[9]	STAGG C J, ANTAL A, NITSCHE M A. Physiology of transcranial direct current stimulation[J]. J ECT, 2018, 34(3): 144-152. doi: 10.1097/YCT.0000000000000510 pmid: 29877965
[10]	NITSCHE M A, COHEN L G, WASSERMANN E M, et al. Transcranial direct current stimulation: state of the art 2008[J]. Brain Stimul, 2008, 1(3): 206-223. doi: 10.1016/j.brs.2008.06.004 pmid: 20633386
[11]	PAULUS W, ROTHWELL J C. Membrane resistance and shunting inhibition: where biophysics meets state‐dependent human neurophysiology[J]. J Physiol, 2016, 594(10): 2719-2728. doi: 10.1113/tjp.2016.594.issue-10
[12]	LEE S, KIM M K. The effect of transcranial direct current stimulation combined with visual cueing training on motor function, balance, and gait ability of patients with Parkinson's disease[J]. Medicina (Kaunas), 2021, 57(11): 1146.
[13]	TALAR K, VETROVSKY T, VAN HAREN M, et al. The effects of aerobic exercise and transcranial direct current stimulation on cognitive function in older adults with and without cognitive impairment: a systematic review and meta-analysis[J]. Ageing Res Rev, 2022, 81: 101738. doi: 10.1016/j.arr.2022.101738
[14]	OLIVEIRA P C A, ARAUJO T A B, MACHADO D G S, et al. Transcranial direct current stimulation on Parkinson's disease: systematic review and meta-analysis[J]. Front Neurol, 2022, 12: 794784. doi: 10.3389/fneur.2021.794784
[15]	CAMMISULI D M, CIGNONI F, CERAVOLO R, et al. Transcranial direct current stimulation (tDCS) as a useful rehabilitation strategy to improve cognition in patients with Alzheimer's disease and Parkinson's disease: an updated systematic review of randomized controlled trials[J]. Front Neurol, 2022, 12: 798191. doi: 10.3389/fneur.2021.798191
[16]	DESJARDINS C, NILLES C, DEVOS D, et al. Apomorphine monotherapy for Parkinson's disease: a neglected option?[J]. J Mov Disord, 2023, 16(3): 328-330. doi: 10.14802/jmd.23057 pmid: 37291833
[17]	PALMA J A, THIJS R D. Non-pharmacological treatment of autonomic dysfunction in Parkinson's disease and other synucleinopathies[J]. [ahead of print] J Parkinsons Dis, 2023. DOI: 10.3233/JPD-230173.
[18]	BIUNDO R, WEIS L, FIORENZATO E, et al. Double-blind randomized trial of tDCS versus sham in Parkinson patients with mild cognitive impairment receiving cognitive training[J]. Brain Stimul, 2015, 8(6): 1223-1225. doi: 10.1016/j.brs.2015.07.043
[19]	MANENTI R, BRAMBILLA M, BENUSSI A, et al. Mild cognitive impairment in Parkinson's disease is improved by transcranial direct current stimulation combined with physical therapy[J]. Mov Disord, 2016, 31(5): 715-724. doi: 10.1002/mds.v31.5
[20]	BLOEM B R, OKUN M S, KLEIN C. Parkinson's disease[J]. Lancet, 2021, 397(10291): 2284-2303. doi: 10.1016/S0140-6736(21)00218-X pmid: 33848468
[21]	HOEHN M M, YAHR M D. Parkinsonism: onset, progression and mortality[J]. Neurology, 1967, 17(5): 427-442. doi: 10.1212/wnl.17.5.427 pmid: 6067254
[22]	孙莉, 王舒, 叶维, 等. 经颅直流电刺激联合计算机辅助认知康复训练改善帕金森病认知障碍的临床疗效观察[J]. 中国康复, 2020, 35(6): 308-311.
	SUN L, WANG S, YE W, et al. Clinical efficacy of transcranial direct current stimulation combined with cognitive training in the improvement of cognitive impairment in Parkinson disease[J]. Chin J Rehabil, 2020, 35(6): 308-311.
[23]	朱胜巍. 经颅直流电刺激联合普拉克索治疗帕金森病的疗效观察[J]. 西藏医药, 2020, 41(2): 73-74.
	ZHU S W. Efficacy of transcranial direct current stimulation combined with pramipexole in the treatment of Parkinson's disease[J]. Tibetan Med, 2020, 41(2): 73-74.
[24]	李学, 张俊红, 祁亚伟, 等. 经颅直流电刺激对早期未治疗帕金森病患者认知功能及听觉事件相关电位的影响[J]. 中华物理医学与康复杂志, 2018, 40(3): 198-201.
	LI X, ZHANG J H, QI Y W, et al. Effects of transcranial direct current stimulation on cognitive function auditory event-related potentials in patients with early untreated Parkinson's disease[J]. Chin J Phys Med Rehabil, 2018, 40(3): 198-201
[25]	王广君, 赵振华, 吴东川, 等. 经颅直流电刺激对帕金森病非运动症状的疗效[J]. 中国医药导报, 2016, 13(5): 75-78.
	WANG G J, ZHAO Z H, WU D C, et al. Effect of transcranial direct current stimulation for non-motor symptoms of Parkinson's disease[J]. Chin Med Herald, 2016, 13(5): 75-78.
[26]	胡喜莲, 薛翠萍, 刘自双. 经颅直流电刺激辅助功能康复训练对帕金森病患者康复的效果[J]. 中国老年学杂志, 2021, 41(17): 3724-3727.
	HU X L, XUE C P, LIU Z S. Effectiveness of transcranial direct current stimulation-assisted functional rehabilitation training on the rehabilitation of patients with Parkinson's disease[J]. Chin J Gerontol, 2021, 41(17): 3724-3727.
[27]	LAWRENCE B J, GASSON N, JOHNSON A R, et al. Cognitive training and transcranial direct current stimulation for mild cognitive impairment in Parkinson's disease: a randomized controlled trial[J]. Parkinsons Dis, 2018, 2018: 4318475
[28]	MANENTI R, COTELLI M S, COBELLI C, et al. Transcranial direct current stimulation combined with cognitive training for the treatment of Parkinson disease: a randomized, placebo-controlled study[J]. Brain Stimul, 2018, 11(6): 1251-1262. doi: S1935-861X(18)30250-X pmid: 30056141
[29]	KNOTKOVA H, PORTENOY R K, CRUCIANI R A. Transcranial direct current stimulation (tDCS) relieved itching in a patient with chronic neuropathic pain[J]. Clin J Pain, 2013, 29(7): 621-622. doi: 10.1097/AJP.0b013e31826b1329 pmid: 23328331
[30]	RIZZO V, TERRANOVA C, CRUPI D, et al. Increased transcranial direct current stimulation after effects during concurrent peripheral electrical nerve stimulation[J]. Brain Stimul, 2014, 7(1): 113-121. doi: 10.1016/j.brs.2013.10.002 pmid: 24388283
[31]	KOOPS S, VAN DEN BRINK H, SOMMER I E C. Transcranial direct current stimulation as a treatment for auditory hallucinations[J]. Front Psychol, 2015, 6: 244. doi: 10.3389/fpsyg.2015.00244 pmid: 25798123
[32]	DOBBS B, PAWLAK N, BIAGIONI M, et al. Generalizing remotely supervised transcranial direct current stimulation (tDCS): feasibility and benefit in Parkinson's disease[J]. J Neuroeng Rehabil, 2018, 15(1): 114. doi: 10.1186/s12984-018-0457-9 pmid: 30522497
[33]	ROHEGER M, XU H, HOANG M T, et al. Conversion between the mini-mental state examination and the Montreal cognitive assessment for patients with different forms of dementia[J]. J Am Med Dir Assoc, 2022, 23(12): 1986-1989. doi: 10.1016/j.jamda.2022.03.018 pmid: 35561758
[34]	SUAREZ-GARCÍA D M A, GRISALES-CÁRDENAS J S, ZIMERMAN M, et al. Transcranial direct current stimulation to enhance cognitive impairment in Parkinson's disease: a systematic review and meta-analysis[J]. Front Neurol, 2020, 11: 597955. doi: 10.3389/fneur.2020.597955
[35]	FABBRI M, BARBOSA R, RASCOL O. Off-time treatment options for Parkinson's disease[J]. Neurol Ther, 2023, 12(2): 391-424. doi: 10.1007/s40120-022-00435-8 pmid: 36633762
[36]	CAPPELLETTI C, HENRIKSEN S P, GEUT H, et al. Transcriptomic profiling of Parkinson's disease brains reveals disease stage specific gene expression changes[J]. Acta Neuropathol, 2023, 146(2): 227-244. doi: 10.1007/s00401-023-02597-7
[37]	LIMA E, DE SOUZA NETO J M R, ANDRADE S M. Effects of transcranial direct current stimulation on lower limb function, balance and quality of life after stroke: a systematic review and meta-analysis[J]. Neurol Res, 2023, 45(9): 843-853. doi: 10.1080/01616412.2023.2211457

结局指标	纳入研究数/n	异质性检验		效应模型	Meta分析结果
结局指标	纳入研究数/n	I²值/%	P值	效应模型	MD(95%CI)	P值
MoCA评分^{[22⇓⇓⇓-26]}	5	66	0.020	随机效应模型	2.00(1.13, 2.87)	< 0.001
病程> 2年^{[22-23,25-26]}	4	40	0.170	固定效应模型	1.59(1.12, 2.06)	< 0.001
PDQ-39评分^[19,27-28]	3	0	0.410	固定效应模型	0.73(-5.78, 7.23)	0.830
BDI-Ⅱ评分^[19,28]	2	65	0.090	随机效应模型	-0.77(-7.14, 5.60)	0.810
UPDRS-Ⅲ评分^[19,28]	2	0	1.000	固定效应模型	1.60(-0.77, 3.97)	0.190

结局指标	研究数量/n	样本量/n	局限性	不一致性
MoCA评分	5	286	0	降一级^a
PDQ-39评分	3	56	0	0
结局指标	间接性	不准确性	发表偏倚	证据等级
MoCA评分	0	降一级^b	降一级^c	极低
PDQ-39评分	0	降一级^b	0	中等

Effect of transcranial direct current stimulation on cognitive function and quality of life in patients with Parkinson's disease: a meta-analysis

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 5

References 37

Related Articles 15

Metrics

Comments

Recommended 0

[1]	GAO Ling, CHU Fengming, JIA Fan, CHEN Jie, ZHANG Ming. Effect of brain-computer interface based on visual, auditory and motor feedback combined with transcranial direct current stimulation on upper limb function in stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(2): 202-209.
[2]	ZHOU Zhining, ZHOU Rong, XIAO Yanwen, WANG Bowen, LÜ Jiaojiao, LIU Yu. Effect of multi-target transcranial direct current stimulation on performance of working memory-postural control dual-task in healthy adults [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 21-28.
[3]	WANG Hangyu, GE Keke, FAN Yonghong, DU Lilu, ZOU Min, FENG Lei. Effect of active music therapy on cognitive function for older adults with cognitive impairment: a systematic review based on ICD-11 and ICF [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 36-43.
[4]	WANG He, HAN Liang, KAN Mengfan, YU Shaohong. Efficacy of electrical stimulation on shoulder-hand syndrome after stroke: a systematic review and meta-analysis [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1048-1056.
[5]	WANG Haiyun, WANG Yin, ZHOU Xinjie, HE Aiqun. Effect of transcranial direct current stimulation combined with acupuncture on central and upper limb function in stroke patients based on central-peripheral-central theory [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 919-925.
[6]	LI Fang, HUO Su, DU Jubao, LIU Xiuzhen, LI Xiaoshuang, SONG Weiqun. Effect of transcranial direct current stimulation combined with task-oriented rehabilitation training on forelimb motor dysfunction in rats with spinal cord injury [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(7): 777-781.
[7]	LIN Yufan, WEI Tianyuan, ZHANG Xiaoying, LI Chaojinzi, HE Jingjie, DU Xiaoxia. Effect of music therapy on post-stroke cognitive impairment [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(6): 714-719.
[8]	CAI Qian, XU Liang, YANG Xi, LIU Jin, MA Ming. Effect of anodal or cathodal transcranial direct current stimulation on upper limb function of stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(5): 521-526.
[9]	CHEN Tiantian, XU Dongping, SUN Fengbao, LAI Junmei, ZENG Duchun. Effect of transcranial direct current stimulation combined with contralateral control functional electrical stimulation on upper limb function of stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(5): 527-532.
[10]	YU Ge, WANG Lu, CHEN Yaping. Effects of whole body vibration training on postural stability in chronic ankle instability: a meta-analysis [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(4): 423-432.
[11]	WANG Haibo, TAO Yuanyuan, LI Jing, SUN Jianjun, XIE Tianpei, QIU Hao, FAN Yingjie, LI Jianjun, SU Min. Effect of transcranial direct current stimulation combined with constraint-induced weight training of the affected lower limb on Pusher syndrome after stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(3): 269-274.
[12]	PANG Zhengzheng, LÜ Yaxi, GAO Chunhua, YU Liguo, ZHANG Huan. Effect of transcranial direct current stimulation on upper limb motor function of patients with stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(3): 275-279.
[13]	ZHANG Liying, WANG Jiening, YU Xiaoming. Effect of robot-assisted training on upper limb motor in patients with stroke: a meta-analysis [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(2): 156-166.
[14]	SUN Ximei, LIU Hua, CHAI Liangwei, LI Kaiyang, MA Jing. Effect of therapeutic exercise on functional disability and quality of life in patients with forward head posture and neck pain: a meta-analysis [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(2): 214-222.
[15]	ZENG Yaqin, CHENG Ruidong, ZHANG Li, FANG Shan, DAI Yunlan, LÜ Qian, GONG Xinyi, YE Xiangming. Effect of high-definition transcranial direct current stimulation combined with rehabilitation robot on upper limb and hand function in patients with subacute stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(11): 1327-1332.