Table 1_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.docx

ObjectiveThe 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.
MethodsPubMed, 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).
ResultsA 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.
ConclusiontDCS 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.
Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier [CRD42024561767].

随着卒中患病率的不断攀升，卒中后认知障碍（post-stroke cognitive impairment, PSCI）的发病率亦随之上升，使其成为卒中幸存者最严重且最常见的并发症之一。目前学界日益关注联合治疗或多模式疗法能否通过叠加或协同效应改善预后，促使更多研究者探索经颅直流电刺激（transcranial direct current stimulation, tDCS）联合认知康复（cognitive rehabilitation, CR）在该人群中的疗效。本研究旨在对tDCS联合CR对PSCI患者认知功能与日常生活活动能力（activities of daily living, ADL）的影响进行系统评价与荟萃分析。

系统检索PubMed、Web of Science、Cochrane图书馆、Embase及中国知网（China National Knowledge Infrastructure, CNKI）建库至2024年6月的相关文献。由2名独立研究者分别筛选文献、提取数据。采用Cochrane偏倚风险工具对纳入的随机对照试验（randomized controlled trial, RCT）的方法学质量进行评价。使用R统计软件（版本4.1.2）开展荟萃分析。

共纳入2013至2024年发表的11项RCT，涉及663名受试者。荟萃分析结果显示，与对照组相比，tDCS联合CR可显著改善PSCI患者的认知功能与ADL，具体表现为蒙特利尔认知评估量表（Montreal Cognitive Assessment, MoCA）（均数差MD=3.03，95%置信区间CI：2.07~3.99，P<0.0001）、简易精神状态检查量表（Mini-Mental State Examination, MMSE）（MD=1.73，95%CI：-0.05~3.52，P<0.05）、洛文斯顿作业疗法认知评定量表（Loewenstein Occupational Therapy Cognitive Assessment, LOTCA）（MD=11.98，95%CI：10.02~13.93，P<0.0001）、日常生活活动能力量表（Activity of Daily Living Scale, ADLs）（MD=2.54，95%CI：0.76~4.31，P<0.05）及改良Barthel指数（Modified Barthel Index, MBI）（MD=5.23，95%CI：1.82~8.64，P<0.01）。亚组分析结果显示，tDCS联合计算机辅助认知康复（computer-assisted cognitive rehabilitation, CACR）对ADL的改善效果更为突出。

tDCS联合CR可显著改善PSCI患者的认知功能与ADL。与传统认知康复相比，计算机辅助认知康复在改善PSCI患者ADL方面具有更优的效果。

系统评价注册链接：https://www.crd.york.ac.uk/PROSPERO/，注册编号[CRD42024561767]。