Data_Sheet_1_A map of evidence using transcranial direct current stimulation (tDCS) to improve cognition in adults with traumatic brain injury (TBI).pdf

IntroductionCognition impairments often occur after a traumatic brain injury and occur at higher rates in military members. Cognitive symptoms impair daily function, including balance and life quality, years after the TBI. Current treatments to regain cognitive function after TBI, including medications and cognitive rehabilitation, have shown limited effectiveness. Transcranial direct current stimulation (tDCS) is a low-cost, non-invasive brain stimulation intervention that improves cognitive function in healthy adults and people with neuropsychologic diagnoses beyond current interventions. Despite the available evidence of the effectiveness of tDCS in improving cognition generally, only two small TBI trials have been conducted based on the most recent systematic review of tDCS effectiveness for cognition following neurological impairment. We found no tDCS studies that addressed TBI-related balance impairments.
MethodsA scoping review using a peer-reviewed search of eight databases was completed in July 2022. Two assessors completed a multi-step review and completed data extraction on included studies using a priori items recommended in tDCS and TBI research guidelines.
ResultsA total of 399 results were reviewed for inclusion and 12 met the criteria and had data extracted from them by two assessors using Google Forms. Consensus on combined data results included a third assessor when needed. No studies using tDCS for cognition-related balance were found.
DiscussionGuidelines and technology measures increase the identification of brain differences that alter tDCS effects on cognition. People with mild-severe and acute-chronic TBI tolerated and benefited from tDCS. TBI-related cognition is understudied, and systematic research that incorporates recommended data elements is needed to advance tDCS interventions to improve cognition after TBI weeks to years after injury.

引言：创伤性脑损伤（traumatic brain injury, TBI）后常出现认知障碍，且在军人中发病率更高。伤后数年，认知症状仍会损害日常功能，包括平衡能力与生活质量。当前用于恢复TBI后认知功能的治疗手段（包括药物治疗与认知康复）效果有限。经颅直流电刺激（transcranial direct current stimulation, tDCS）是一种低成本、非侵入性的脑刺激干预方式，相较于现有干预手段，其可改善健康成年人及神经心理疾病患者的认知功能。尽管已有证据表明tDCS总体上可改善认知功能，但根据最新的针对神经损伤后认知功能的tDCS有效性系统综述，目前仅开展了两项小型TBI相关临床试验。本研究尚未发现针对TBI相关平衡障碍的tDCS研究。
方法：本研究于2022年7月完成，采用针对8个数据库的同行评议检索策略开展范围综述。由2名评估人员完成多阶段审查，并依据tDCS与TBI研究指南中推荐的预先设定条目，对纳入研究进行数据提取。
结果：本研究共检索到399条结果并进行纳入筛选，最终有12项研究符合标准，由2名评估人员通过谷歌表单（Google Forms）完成数据提取。必要时可引入第三名评估人员以达成合并数据结果的共识。本研究未发现将tDCS用于认知相关平衡功能研究的文献。
讨论：现有指南与技术手段可提升对脑差异的识别能力，而脑差异会改变tDCS对认知功能的作用效果。轻至重度、急性至慢性期的TBI患者均可耐受tDCS并从中获益。目前针对TBI相关认知功能的研究仍不足，需开展纳入推荐数据要素的系统性研究，以推动tDCS干预手段的发展，从而改善伤后数周至数年的TBI患者的认知功能。