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September 10, 2025Open Access

Impact of Repetitive Transcranial Magnetic Stimulation on Cognitive Impairment in Stroke Patients: A Meta-Analysis of Randomized Controlled Trials

ZZZhiqiang ZhaoShenyang University of Technology HLHuai-Nan LiTongliao Academy of Agricultural Sciences YYYun YeZhejiang Chinese Medical University

Key Points

Repetitive transcranial magnetic stimulation significantly improves cognitive function in stroke patients, with an effect size of 0.54.
The study pooled data from 14 trials involving 597 stroke patients, highlighting the benefits of high-intensity rTMS and intermittent theta-burst stimulation.
The meta-analysis assessed cognitive outcomes using various scales, showing positive effects on the Modified Barthel Index and the Montreal Cognitive Assessment.
Future research should address the limitations of the current studies to validate the findings and explore optimal rTMS application.

Abstract

To evaluate the impact of repetitive transcranial magnetic stimulation (rTMS) on cognitive impairment in stroke patients using meta-analysis. Electronic databases (PubMed, Web of Science, Cochrane Library, and Embase) were systematically searched up to October 20, 2024. Randomized controlled trials assessing the effect of rTMS on cognitive impairment in stroke patients were included. Pooled effect sizes were calculated using standardized mean differences (SMD) or mean differences (MD) based on fixed or random effects models. Fourteen studies involving 597 stroke patients were included in this meta-analysis. The results showed that rTMS significantly improved global cognitive function in stroke patients (SMD: 0.54; 95% CI: 0.28, 0.79), particularly with high-intensity rTMS (SMD: 0.41; 95% CI: 0.07, 0.76) and intermittent theta-burst stimulation (iTBS) (SMD: 0.94; 95% CI: 0.62, 1.27). In terms of different rating scales, rTMS significantly increased scores on the Modified Barthel Index (MBI) (MD: 10.54; 95% CI: 4.85, 16.23) and the Montreal Cognitive Assessment (MoCA) (MD: 1.96; 95% CI: 0.91, 3.01), while the effects on the Mini-Mental State Examination (MMSE), Rivermead Behavioral Memory Test (RBMT), and Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) were not statistically significant. This meta-analysis confirms that rTMS can effectively improve cognitive function in stroke patients. However, due to the limited number of studies included, further high-quality research is needed to substantiate our findings.

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