Accepted for/Published in: JMIR Research Protocols
Date Submitted: May 23, 2025
Date Accepted: Sep 3, 2025
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Study on the use of repetitive transcranial magnetic stimulation to improve cognitive impairment in stroke patients based on rs-fMRI findings: A protocol for meta-analysis
ABSTRACT
Background:
Post-stroke cognitive impairment (PSCI) is a chronic form of post-stroke cognitive dysfunction that affects approximately one-third of stroke survivors. PSCI significantly increases rates of mortality and functional disabilities, such as limitations in motor function, speech, and activities of daily living (ADL). Therefore, effective treatments are needed for patients with PSCI. Repetitive transcranial magnetic stimulation (rTMS) has been shown exert beneficial behavioral effects among patients with PSCI. More importantly, a limited number of neuroimaging studies with small sample sizes have reported the beneficial effects of rTMS on brain plasticity and its reciprocal influence on cognitive behavioral performance. Resting-state functional magnetic resonance imaging (rs-fMRI) has been widely used for studying changes in brain activity, but there is no consensus regarding which brain regions play pivotal roles in rTMS for patients with PSCI.
Objective:
This study aims to explore the therapeutic effects of rTMS on changes in brain activity in PSCI patients, thereby providing robust evidence to elucidate its neuroimaging mechanisms.
Methods:
In this meta-analysis, the PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Technology Periodical Database (VIP), and China WanFang Database will be systematically searched up to December 2024 to identify randomized controlled trials (RCTs) with the aim of comparing active rTMS against sham stimulation conditions or conventional control condition(s) among patients with PSCI. Primary outcomes will include the amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo), and functional connectivity (FC) across the whole brain. The secondary outcomes will include the MoCA and MMSE scores. Statistical analyses will be conducted via Review Manager 5.4, SDM-PSI 6.23, and STATA 18.0 software to assess study quality, to evaluate the risk of bias, and to analyze the outcome measures.
Results:
The results of this meta-analysis will offer a comprehensive analysis of the available evidence on the use of rTMS to improve cognitive impairment in stroke patients based on rs-fMRI findings. The meta-analysis commenced in July 2024 and will be completed in July 2025. Data analysis will begin in August 2025 and results will be published in September 2025.
Conclusions:
This meta-analysis will provide insight into the therapeutic potential of rTMS to improve cognitive impairment in stroke patients. It will also highlight the strengths and limitations of the existing literature, and suggest directions for future research. Ultimately, our study may aid future clinical decision-making concerning PSCI rehabilitation programs and provide evidence-based medical insights into the neuroimaging mechanisms of rTMS treatment for PSCI. Clinical Trial: PROSPERO registration number CRD42024562477.
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