Background Post-stroke cognitive impairment (PSCI) severely affects patients’ daily living and independence, with limited treatment options. Repetitive transcranial magnetic stimulation (rTMS) shows promise but inconsistencies in reported effect sizes across cognitive domains.Methods We systematically searched PubMed, Web of Science, Cochrane Library, and EMBASE up to March 2026 for randomized controlled trials evaluating rTMS combined with rehabilitation versus sham or rehabilitation alone in stroke patients. Outcomes included MMSE, MoCA, Digit Span Test (DST), and modified Barthel Index (MBI). Meta-analysis was performed using RevMan 5.4.Results Ten RCTs involving 666 patients were included. rTMS significantly improved MMSE (MD = 1.76, 95%CI[1.10, 2.43], p < 0.00001, I2 = 5%) and MoCA scores (MD = 2.64, 95% CI[1.74,3.55], p < 0.00001, I2 = 0%). No significant effect was found on DST-forward (p = 0.13), but DST-backward showed mild improvement (MD = 0.77, 95% CI[0.35,1.18], p = 0.0003, I2 = 62%). MBI scores were significantly enhanced (MD = 10.68, 95% CI[7.91,13.46], p < 0.00001, I2 = 0%).Conclusion Based on low-to-moderate certainty evidence, rTMS combined with rehabilitation may improve global cognitive screening performance and daily living ability in stroke patients, with a mild benefit on working memory. Further studies are needed to optimize stimulation protocols.
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Wang et al. (2026) studied this question.
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