Objective: To evaluate the effectiveness of combined high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) on cognitive rehabilitation in patients with ischemic stroke after 15 treatment sessions.
Subjects and methods: A randomized controlled trial was conducted on 40 patients with cognitive impairment following first-ever ischemic stroke, receiving inpatient treatment at the National Rehabilitation Hospital. Patients were randomly assigned to an intervention group (HF-rTMS, n = 20) and a control group (sham rTMS, n = 20). Improvement was assessed using the MoCA, the FAB, the VST-C and the Barthel index before and after 15 intervention sessions.
Results: After 15 sessions, the intervention group showed significant improvement across all four scales (p < 0.05). The improvement in the intervention group was significantly greater than that in the control group for FAB (Δ 1.30 points vs. 0.50 points; p < 0.001), VST-C (reduction of 8.90 seconds vs. 4.00 seconds; p < 0.001), and the Barthel Index (Δ 18.50 points vs. 8.75 points; p < 0.001). The final MoCA and FAB scores were not significantly different between the two groups (MoCA: p = 0.193; FAB: p = 0.085). No adverse effects were recorded in any patient during the intervention.
Conclusions: HF-rTMS is a safe, non-invasive brain stimulation method that improves executive function (FAB, VST-C) and independence in activities of daily living (Barthel index) in patients with post-stroke cognitive impairment. The improvement in MoCA was also significantly greater in the intervention group than in the control group (p = 0.010), although this did not translate into a significant difference in final scores between the two groups.