Transcranial pulse stimulation in the treatment of cognitive disorders of aging: a systematic review

Introduction Non-invasive brain stimulation techniques, specifically transcranial pulse stimulation (TPS) are of increasing interest due to their potential to fill in gaps left by current pharmacological treatments in cognitive disorders of aging. The current review’s aims were to systematically determine what cognitive disorders of aging have been studied with TPS as a treatment and to narratively summarize what is known about the effectiveness of TPS treatment in the aging subpopulation through neurocognitive performance metrics and neuroimaging metrics. Methods This review is PRISMA 2020 compliant. Searches were conducted in PubMed, PsycINFO (through PsycNET to include all APA Databases), Embase, and Scopus. Title/Abstract screening, full text screening, and extraction were completed by two independent reviewers with discrepancies worked out through discussion. Outcomes were systematically chosen for formal analysis where dual reviewers completed risk of bias and certainty of evidence assessments, and remaining outcomes were synthesized narratively. Results 11 studies were included, consisting of 10 nonrandomized studies and 1 randomized controlled trial (RCT). Due to follow ups and suspected cohort overlap, the 11 studies are not representative of 11 independent patient cohorts. Included studies examined Alzheimer’s Disease and related dementias, mild neurocognitive disorder, mild cognitive impairment and Parkinson’s Disease through a variety of neurocognitive performance metrics and neuroimaging metrics. Formal synthesis showed a preliminary trend for positive change from before to after stimulation, particularly in neuropsychological batteries measuring global cognition, however number of contributing results and overall certainty of evidence were both very low. Neuroimaging results varied with trends of statistically significant functional changes, though also limited by limited literature and low certainty. Discussion Though there is a continued need for high quality research and randomized controlled trials using TPS in the treatment of neurocognitive disorders of aging, the current evidence indicates potential for promising changes in neurocognitive performance metric outcomes and functional neuroimaging measures from before to after stimulation pending additional controlled trials. Though there is currently not enough high quality evidence to support clinical recommendations, what is known could support the use of TPS in the treatment of neurocognitive disorders of aging should RCTs continue to support positive improvements associated with this non-invasive intervention. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420251246424.