经颅直流电刺激对脑卒中后轻中度认知障碍患者认知功能康复效果的系统评价与meta分析

doi:10.3969/j.issn.1004-583X.2025.07.001

摘要/Abstract

摘要：

目的对采用经颅直流电刺激(tDCS)干预脑卒中后轻中度认知障碍患者认知功能的临床随机对照试验(RCTs)进行系统评价及meta分析并评价其效果。方法在中外文数据库中检索采用tDCS治疗脑卒中后轻中度认知障碍患者认知功能的RCTs,使用Cochrane偏倚风险评估工具对纳入文献进行质量评价,采用RevMan 5.4软件对相关指标进行meta分析。结果文献共纳入11篇,患者共计481例,meta分析结果显示整体认知功能的MoCA评分[MD=1.44, 95%CI(0.86, 2.02), P<0.01]和MMSE评分[MD=1.39, 95%CI(0.52, 2.26), P=0.002],记忆功能的RBMT评定[MD=1.30, 95%CI(0.43, 2.17), P=0.004]较对照组提高(P<0.05);工作记忆及注意力的DST之FDST[MD=0.28, 95%CI(-0.15, 0.72), P=0.20]与BDST[MD=0.10, 95%CI(-0.23, 0.44), P=0.55]较对照组差异无统计学意义(P>0.05)。结论 tDCS干预可有效改善脑卒中后轻中度认知障碍患者的整体认知功能及记忆功能。

关键词: 经颅直流电刺激, 认知功能, 系统评价, Meta分析

Abstract:

Objective To systematically review the randomized controlled trials (RCTs) on the effect of transcranial direct current stimulation (tDCS) on cognitive function in patients with mild-to-moderate cognitive impairment after stroke, and conduct a meta-analysis. Methods Randomized clinical trials (RCTs) of cognitive function in patients with mild-to-moderate cognitive impairment after stroke treated with tDCS were retrieved from the Chinese-language and English-language databases. The quality of the included literatures was evaluated using the Cochrane bias risk assessment tool, and the related indicators were analyzed via a meta-analysis using RevMan 5.4 software. Results A total of 11 literatures involving 481 subjects were included. The results of meta-analysis showed that the Montreal Cognitive Assessment (MoCA) score (MD=1.44, 95%CI 0.86, 2.02, P<0.01), and Mini-Mental State Examination (MMSE) score (MD=1.39, 95%CI 0.52, 2.26, P=0.002) indicating overall cognitive function, and Rivermead Behavioural Memory Test(RBMT) score indicating memory ability (MD=1.30, 95%CI 0.43, 2.17, P=0.004) were significantly higher in the treated group than the control group. The Digit Span Test (DST) encompassing both forward (FDST for attention, MD=0.28, 95%CI -0.15, 0.72, P=0.20) and backward (BDST for working memory, MD=0.10, 95%CI -0.23, 0.44, P=0.55) recall were comparable between groups. Conclusion tDCS can effectively improve the overall cognitive function and memory function of patients with mild-to-moderate cognitive impairment after stroke.

Key words: transcranial direct current stimulation, cognitive function, systematic evaluation, meta analysis

中图分类号:

R454.1

苏桂婷, 康雅红, 陈梓琼, 刘芳. 经颅直流电刺激对脑卒中后轻中度认知障碍患者认知功能康复效果的系统评价与meta分析[J]. 临床荟萃, 2025, 40(7): 581-588.

Su Guiting, Kang Yahong, Chen Ziqiong, Liu Fang. Effect of transcranial direct current stimulation on cognitive rehabilitation in patients with mild-to-moderate cognitive impairment after stroke: A systematic review and meta-analysis[J]. Clinical Focus, 2025, 40(7): 581-588.

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链接本文: http://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2025.07.001

http://www.lchc.cn/CN/Y2025/V40/I7/581

图/表 8

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第一作者及时间	诊断标准		年龄 (岁)	例数(对照组/试验组)	干预措施		电流强度 (mA)	干预频率 (每周)	干预周期 (周)	结局指标
第一作者及时间	脑卒中	认知障碍程度	年龄 (岁)	例数(对照组/试验组)	对照组	试验组	电流强度 (mA)	干预频率 (每周)	干预周期 (周)	结局指标
Chen 2024^[7]	①⑥	⑦	E:61.06±3.08 C:62.44±2.76	18/18	计算机辅助认知训练	计算机辅助认知训练+tDCS	2	20 min/次,1次/d,5 d	3	MoCA
石琪2024^[8]	①	⑦	E:72.31±3.46 C:71.05±3.17	31/31	盐酸多奈哌齐	盐酸多奈哌齐+tDCS	1~2	20 min/次,1次/d,5 d	4	MoCA、RBMT
张雪婷2024^[9]	②	③⑦	E:61.56±5.01 C:59.23±4.38	34/33	常规治疗	常规治疗+tDCS	1.5	15 min/次,1次/d,5 d	4	MoCA、LOTCA、RBMT
杜晴晴2023^[10]	④⑥	⑧	E1:55.67±7.75 E2:52.40±8.77 C:56.60±8.03	15/15/15	认知训练+假tDCS	E1:认知训练和tDCS同时进行 E2:先tDCS后认知训练	1.4	30 min/次,1次/d,5 d	2	MMSE、MoCA、DST、n-back
徐盼盼2022^[11]	④⑥	⑦	E:59.53±5.99 C:59.80±6.86	15/15	常规康复治疗+认知功能训练+假tDCS	常规康复治疗+认知功能训练+tDCS	2.0	30 min/次,1次/d,5 d	3	MoCA、RBMT
杨健2022^[12]	⑥	⑧	E:56.19±7.541 C:54.84±8.041	32/32	常规药物、康复治疗+认知训练	常规药物、康复治疗+认知训练+tDCS	1.0	20 min/次,2次/d,5 d	2	MMSE、MoCA
Ko 2022^[13]	未注明	⑨	E:61.25±12.85 C:57.86±10.04	13/13	认知训练+假远程tDCS	认知训练+远程tDCS	2.0	30 min/次,1次/d,5 d	4	K-MoCA、SCWT、K-BNT、K-DRS-2、TMT、Go/No Go、COWAT
艾一楠2021^[14]	④⑥	⑧	E1:61.64±10.33 E2:61.36±8.51 C:58.77±9.61	14/14/13	常规康复治疗+计算机辅助认知康复训练+假tDCS	E1:常规康复治疗+计算机辅助认知康复训练+tDCS(与认知康复同时进行) E2:常规康复治疗+计算机辅助认知康复训练+tDCS(与认知康复隔4h以上)	2.0	30 min/次,1次/d,5 d	2	MoCA、DST
刘远文2021^[15]	未注明	⑧	E:63.72±8.41 C:60.06±8.26	20/20	常规康复治疗+假tDCS	常规康复治疗+tDCS	2.0	20 min/次,1次/d,5 d	4	MMSE、DST、TMT、DS
张晓杰2020^[16]	⑤⑥	⑦	E:53.43±10.79 C:54.37±12.21	15/15	常规康复方案+认知训练+假tDCS	常规康复方案+认知训练+tDCS	1.5	20 min/次,1次/d,5 d	3	MoCA、SCWT
Shaker 2018^[17]	⑥	⑧	E:54.45±4.68 C:53.05±6.32	20/20	认知功能训练+假tDCS	认知功能训练+tDCS	2.0	30 min/次,1次/d,3 d	4	ACL、FML、RBL、LRL

第一作者及时间	诊断标准		年龄 (岁)	例数(对照组/试验组)	干预措施		电流强度 (mA)	干预频率 (每周)	干预周期 (周)	结局指标
第一作者及时间	脑卒中	认知障碍程度	年龄 (岁)	例数(对照组/试验组)	对照组	试验组	电流强度 (mA)	干预频率 (每周)	干预周期 (周)	结局指标
Chen 2024^[7]	①⑥	⑦	E:61.06±3.08 C:62.44±2.76	18/18	计算机辅助认知训练	计算机辅助认知训练+tDCS	2	20 min/次,1次/d,5 d	3	MoCA
石琪2024^[8]	①	⑦	E:72.31±3.46 C:71.05±3.17	31/31	盐酸多奈哌齐	盐酸多奈哌齐+tDCS	1~2	20 min/次,1次/d,5 d	4	MoCA、RBMT
张雪婷2024^[9]	②	③⑦	E:61.56±5.01 C:59.23±4.38	34/33	常规治疗	常规治疗+tDCS	1.5	15 min/次,1次/d,5 d	4	MoCA、LOTCA、RBMT
杜晴晴2023^[10]	④⑥	⑧	E1:55.67±7.75 E2:52.40±8.77 C:56.60±8.03	15/15/15	认知训练+假tDCS	E1:认知训练和tDCS同时进行 E2:先tDCS后认知训练	1.4	30 min/次,1次/d,5 d	2	MMSE、MoCA、DST、n-back
徐盼盼2022^[11]	④⑥	⑦	E:59.53±5.99 C:59.80±6.86	15/15	常规康复治疗+认知功能训练+假tDCS	常规康复治疗+认知功能训练+tDCS	2.0	30 min/次,1次/d,5 d	3	MoCA、RBMT
杨健2022^[12]	⑥	⑧	E:56.19±7.541 C:54.84±8.041	32/32	常规药物、康复治疗+认知训练	常规药物、康复治疗+认知训练+tDCS	1.0	20 min/次,2次/d,5 d	2	MMSE、MoCA
Ko 2022^[13]	未注明	⑨	E:61.25±12.85 C:57.86±10.04	13/13	认知训练+假远程tDCS	认知训练+远程tDCS	2.0	30 min/次,1次/d,5 d	4	K-MoCA、SCWT、K-BNT、K-DRS-2、TMT、Go/No Go、COWAT
艾一楠2021^[14]	④⑥	⑧	E1:61.64±10.33 E2:61.36±8.51 C:58.77±9.61	14/14/13	常规康复治疗+计算机辅助认知康复训练+假tDCS	E1:常规康复治疗+计算机辅助认知康复训练+tDCS(与认知康复同时进行) E2:常规康复治疗+计算机辅助认知康复训练+tDCS(与认知康复隔4h以上)	2.0	30 min/次,1次/d,5 d	2	MoCA、DST
刘远文2021^[15]	未注明	⑧	E:63.72±8.41 C:60.06±8.26	20/20	常规康复治疗+假tDCS	常规康复治疗+tDCS	2.0	20 min/次,1次/d,5 d	4	MMSE、DST、TMT、DS
张晓杰2020^[16]	⑤⑥	⑦	E:53.43±10.79 C:54.37±12.21	15/15	常规康复方案+认知训练+假tDCS	常规康复方案+认知训练+tDCS	1.5	20 min/次,1次/d,5 d	3	MoCA、SCWT
Shaker 2018^[17]	⑥	⑧	E:54.45±4.68 C:53.05±6.32	20/20	认知功能训练+假tDCS	认知功能训练+tDCS	2.0	30 min/次,1次/d,3 d	4	ACL、FML、RBL、LRL