Table 4.
Classical and promising approaches in management and brain stimulation.
| Taken for granted | To be clarified-unmet needs | |
|---|---|---|
| Secondary stroke prevention | Interventions for hypertension, smoking, diabetes, hyperlipidemia, obesity, obstructive sleep apnea and physical activity are mandatory | But effect on cognition remains unproven6,7,133 |
| Pharmacological symptomatic treatments | Cholinesterase inhibitors, memantine, dopamine agonists and selective serotonin reuptake inhibitors: no significant benefit on pure vascular PSCI7,135,136 | Refine mechanisms of certain cognitive and behavioral impairments |
| Cognitive rehabilitation | Combination of restorative and compensatory: traditional paper and pencil-based training | Platforms and computerized training: benefit to be documented6,7,137 |
| Noninvasive brain stimulation (NIBS) | Change in excitability of the underlying brain cortex potentially induces long-lasting neuroplastic changes138,139 | Overall benefit and its magnitude of all NIBS methods: needs to be substantiated by large, high-quality sham-controlled randomized trials |
| Repeated transcranial magnetic stimulation (rTMS) | Effects on cortical activity depends on frequency: | |
| - high-frequency (>1 Hz) stimulation promotes local neuronal excitability, | ||
| - low-frequency (⩽1 Hz) stimulation shows inhibitory effects 140 | ||
| Theta-burst stimulation | rTMS technique consisting of 3 pulse bursts at 50 Hz in continuous (inhibition of local cortical excitability) or intermittent forms (facilitation of local cortical excitability)140,141 | Could induce longer duration and more intense neural activity with low-intensity, short duration stimulation than conventional rTMS 142 |
| Transcranial direct current stimulation (tDCS) | Constant, low-intensity direct current (intensity of 0.5–2 mA) applied through two electrodes placed on the scalp; subdivided into anodal (enhances activity of superficial cortical neurons), cathodal (reduces activity of superficial cortical neurons) and dual (both anodal and cathodal) 143 | |
| Transcutaneous vagus nerve stimulation | May modulate brain neurotransmitters release and blood flow to brain areas such as hippocampus and thalamus 144 |