Table 4.
Summarization of the identified studies with low risk of bias.
Study | Population | Stimulation parameters | Research methods | Results | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Type of stimulation | Target region | Location and type of coil / Location and size of electrodes | Duration | Intensity of stimulation | Frequency of stimulation | Method of control | Diagnostic criteria | Randomization | Blinding | Allocation concealment | Interval scaling | Practice effect | Missing data and drop-outs | Other statistical practices | |||
Bystad et al. (2016) | AD | atDCS | Left temporal cortex | According to the 10-20 EEG system: anode: 5 × 7 cm, at T3 cathode: 5 × 7 cm, at Fp2 | 6 sessions, 30 min/session | 2 mA | 30 s active stimulation | Revised NINCDS-ADRDA | Computer randomized list containing 5-digit codes provided by the manufacturer of the tDCS device | Patients and assessor blinded to the type of stimulation | Assignment disclosed until the end of the intervention | Scaling according to standardized norm tables, transformation to z-scores | Two versions of CVLT-II used | Explicitly reported no drop-outs | Sample size based on other studies | No changes in global cognition, verbal learning, attention or executive function | |
Khedr et al. (2014) | AD | atDCS and ctDCS | LDLPFC | Anodal: 10 x 10 cm, right supraorbital region cathodal: 4 x 6 cm, LDLPFC | 10 sessions, 25 min/session | 2 mA | 30 s active stimulation | NINCDS-ADRDA | Computer generated randomization table | Patients and assessor blinded to group assignment the effectiveness of blinding was measured | Serials numbered opaque closed envelopes | Reportedly no drop-outs | Improvement in MMSE after both anodal and cathodal tDCS in contrast to sham, improvement in performance IQ after cathodal stimulation | ||||
Suemoto et al. (2014) | AD | atDCS | LDLPFC | Anode 5 × 7 cm, over DLPFC cathode 5 × 7 cm, right supraorbital region | 6 sessions on every 2nd day, 20 min/session | 2 mA | 20 s active stimulation | NINCDS-ADRDA | Computer-generated list of random numbers | Patients and assessor blinded to condition, numbered | Opaque and sealed envelopes | Reasons of missing data not reported, intention to treat analyses conducted using the method of last observation carried forward | A priori sample size calculation, using the method of minimal clinically relevant difference, planned pairwise comparisons | No change in active and sham group | |||
Wu et al. (2015) | AD | HF-rTMS | LDLPFC | Figure-of-eight coil | 20 sessions, 1,200 pulses/session | 80% of RMT | 20 Hz | Tilted coil (180°) | NINCDS-ADRDA | Standard table of random numbers | Patients and assessor blinded to group assignment | Patients and assessor blinded to the group assignment before starting the trial, method not specified | Using cutoff scores based on the findings of other studies | Improvement of behavioral and global cognitive symptoms | |||
Drumond Marra et al. (2015) | MCI | HF-rTMS | LDLPFC | Figure-of-eight coil 5 cm in a parasagittal plane parallel to the point of maximum rMT | 10 sessions, 2,000 pulses/session | 110% of RMT | 10 Hz | Sham coil | Not specified, MoCA <26 | Computer generated randomization | Patients and assessors blinded to group assignment, the effectiveness of blinding was measured | Different staff members responsible for the allocation | Scores adjusted according to age, gender and education level | Selective improvement in everyday memory compared to sham group | |||
Padala et al. (2018) | MCI | HF-rTMS | LDLPFC | Figure-of-eight coil n.a. | 10 sessions/condition, 3,000 pulses/session | 120% of RMT | 10 Hz | Sham coil | Criteria of Petersen et al. (1999) | Randomized block design | Patients and assessors blinded to condition | Independent staff member responsible for the allocation | Random subject effect calculated | Drop-outs reported and reasoned | Baseline measurements set as covariates | Improvement in apathy symptoms, global cognition, processing speed and clinical improvement compared to sham condition |
AD, Alzheimer's disease; MCI, mild cognitive impairment; HF-rTMS, high frequency repetitive transcranial magnetic stimulation; atDCS, anodal transcranial direct current stimulation; ctDCS, cathodal transcranial direct current stimulation; LDLPFC, left dorsolateral prefrontal cortex; NINCDS-ADRDA, National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Related Disorders Association; RMT, resting motor threshold; EEG, electroencephalography; CVLT-II, California Verbal Learning Test-II; MMSE, Mini-Mental State Examination; MOCA, Montreal Cognitive Assessment Test.