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
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 outco...
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Frontiers Media S.A.
2025-06-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2025.1523001/full |
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| author | Nan Luo Binbin Zhao Hui Wang Jiabei Wu Yifan Luo Man Yuan Chunlan Xu |
| author_facet | Nan Luo Binbin Zhao Hui Wang Jiabei Wu Yifan Luo Man Yuan Chunlan Xu |
| author_sort | Nan Luo |
| collection | DOAJ |
| description | 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]. |
| format | Article |
| id | doaj-art-e28e371d6c1447bbbb5cba2a61f409a6 |
| institution | OA Journals |
| issn | 1664-2295 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
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| spelling | doaj-art-e28e371d6c1447bbbb5cba2a61f409a62025-08-20T02:32:56ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-06-011610.3389/fneur.2025.15230011523001Effect 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-analysisNan Luo0Binbin Zhao1Hui Wang2Jiabei Wu3Yifan Luo4Man Yuan5Chunlan Xu6Department of Nursing, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Nursing, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Nursing, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaNursing College of Shanxi Medical University, Taiyuan, ChinaDepartment of Nursing, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Nursing, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Nursing, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaObjectiveThe 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].https://www.frontiersin.org/articles/10.3389/fneur.2025.1523001/fullpost-stroke cognitive impairmentcognitive rehabilitationtranscranial direct current stimulationmeta-analysiscognitive functionactivities of daily living |
| spellingShingle | Nan Luo Binbin Zhao Hui Wang Jiabei Wu Yifan Luo Man Yuan Chunlan Xu 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 Frontiers in Neurology post-stroke cognitive impairment cognitive rehabilitation transcranial direct current stimulation meta-analysis cognitive function activities of daily living |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | post-stroke cognitive impairment cognitive rehabilitation transcranial direct current stimulation meta-analysis cognitive function activities of daily living |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1523001/full |
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