| [Objective] Cognitive impairment is a common non-motor symptom(NMS)of Parkinson’s disease(PD),which reduce life quality,decrease daily living abilities of independence,and increase mortality.This Metaanalysis analyzed the Randomized Controlled Trials(RCTs),repeated transcranial magnetic stimulation(r TMS)for Parkinson’s disease with cognitive impairment,to assess the treatment effect of r TMS therapy and provide clinical evidence for the application of r TMS.[Methods] We searched electronic databases including Pub Med,Embase,The Cochrane Library,Scopus,CBM,Pro Quest,China National Knowledge Infrastructure(CNKI),Chinese VIP Information(VIP),Wan Fang,Clinical Trials,Clinical Trials.gov and gray literature database Open Gray,an article was retrieved manually.According to the inclusion and exclusion criteria,high-quality RCTs published from 1974 to September 2020 of r TMS for cognitive dysfunction in Parkinson’s disease was selected,two researchers independently conducted the literature screening,data extraction,and quality evaluation.The Meta-analysis was carried on Rev Man 5.3 and Stata13 Software.[Results] A total of 14 articles with 841 cases,including 427 cases in the treatment group,and 424 cases in the control group,were included.This analysis discussed primary outcomes(global cognitive function rating scale:Mini-Mental Status Examination(MMSE),Montreal Cognitive Assessment(Mo CA),and the five cognitive domains: attention,memory,executive functions,language,and visuospatial function)and secondary outcomes(Non-motor symptoms NMS and ability of daily living scale).We analyzed the subgroups of effects duration and cognitive domains,MMSE and Mo CA scales were divided into three subgroups(<1month,1month,>1month)in line with the follow-up time to explore the duration of effects.Primary outcomes : compared with the control group,9 studies showed statistically improvement [WMD = 3.07,95% CI =(2.59,3.55)]in MMSE scores after r TMS treatment immediately;MMSE scores in 6trials improved significantly [WMD = 2.54,95%CI =(1.79,3.30)] at 1month;at >1 month,2 studies showed no statistically improvement [WMD= 0.33,95% CI =(-1.39,2.05)] in MMSE scores.In Mo CA scores,5studies showed significantly improvement [WMD = 4.0,95% CI =(2.65,5.35)] after r TMS treatment immediately;2 studies showed that Mo CA score did not improve [WMD = 1.42,95% CI =(-0.62,3.47)] at 1 month;Mo CA scores in 2 studies showed no statistical significance [WMD = 1.54,95% CI =(-0.92,4.01)] at >1 month.In five cognitive function domains,executive function of treatment group showed statistically evident improvement [WMD = 0.47,95% CI =(0.15,0.80)],while the visuospatial function,memory,attention and language domains did not improve(P > 0.05).Secondary outcomes:r TMS showed no effect on the ability of daily living scale [WMD =-0.73,95% CI =(-2.33,0.86)] of.Non-motor symptoms scale in cognitive impaired PD patients was improved after r TMS treatment [SMD =-0.58,95% CI =(-0.92,-0.24)].[Conclusion] rTMS therapy can improve the global cognitive function and executive ability in cognitive impaired PD patients. |
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