High-frequency versus theta burst transcranial magnetic stimulation for the treatment of poststroke cognitive impairment in humans

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Fig. 1
Mean group values with standard deviations for Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) scores and subtest scores. Statistical analysis through linear regression with age, time since stroke onset, language and education level as explanatory factors. Significant differences between groups were set at p < 0.05. iTBS = intermittent theta burst stimulation; rTMS = repetitive transcranial magnetic stimulation.
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Fig. 2
Subgroup analyses revealed that patients with hypertension (HTN+) yielded lower attention improvement (p = 0.008) than patients with no history of hypertension (HTN−). Statistical analysis through linear regression with age, time since stroke onset, language and education level as explanatory factors. Significant differences between groups were set at p < 0.05.

Table 1

Demographic and clinical characteristics^*

Characteristic	iTBS (n = 15)	5 Hz rTMS (n = 11)	Sham (n = 15)	p value
Age, yr	60.13 ± 14.1	57.45 ± 12.3	56.23 ± 12	0.77
M/F, n	11/4	9/2	13/2	0.65
Education, yr	11.27 ± 5.4	14 ± 2.8	13.64 ± 1.9	0.56
Poststroke duration, mo	18.47 ± 20.21	33.27 ± 26.4	38 ± 7.9	0.016^†
Ischemic stroke/hemorrhagic stroke, n	7/8	3/8	10/5	0.14
Lesion site (cortex + subcortical, or subcortical), n	11/4	10/1	12/3	0.31
Anomic aphasia, n	5	< 5	< 5	0.86
Comorbidities, n
Hypertension	9	< 5	10	0.29
Diabetes mellitus	5	< 5	< 5	0.23
Dyslipidemia	< 5	0	< 5	0.43
RBANS scores
Total	73.7 ± 12.2	69.1 ± 10.9	65.3 ± 16.1	0.19
Immediate memory	73.1 ± 16.6	69.2 ± 20.0	61.3 ± 20.0	0.25
Visuospatial ability	98.9 ± 13.4	87.0 ± 13.9	82.9 ± 15.6	0.17
Language	70.1 ± 14.0	76.3 ± 4.8	63.3 ± 18.1	0.25
Attention	77.5 ± 19.1	70.1 ± 18.9	76.1 ± 20.8	0.52
Delayed memory	79.5 ± 18.8	75.1 ± 21.1	76.1 ± 20.8	0.86
Beck Depression Inventory score	14.5 ± 10.0	13.0 ± 13.2	9.2 ± 8.2	0.27

F = female; iTBS = intermittent theta burst stimulation; M = male; RBANS = Repeatable Battery for the Assessment of Neuropsychological Status; rTMS = repetitive transcranial magnetic stimulation.
↵* Data are mean ± standard deviation unless otherwise specified. Populations of fewer than 5 people have been rounded to protect participant privacy.
↵† One-way analysis of variance for continuous data and a χ² test, with significance levels set at p < 0.05. Post hoc analyses revealed significantly longer disease duration in the 5 Hz rTMS group at baseline (p = 0.016), which we used as an explanatory variable for intergroup comparison. Bonferroni correction: iTBS v. 5 Hz rTMS, Z = −3.776, p = 0.001.

Table 2

Mean RBANS and Beck Depression Inventory scores by group^*

Group	Pre-rTMS	Post-rTMS	Difference	\|Z\|	p value	Power
iTBS
RBANS scores
Total	73.7 ± 12.2	80.1 ± 16.0	6.4 ± 6.2	3.327	0.001	0.95
Immediate memory	73.1 ± 16.5	81.1 ± 20.9	8 ± 9.6	2.737	0.006
Visuospatial ability	98.9 ± 13.4	100.2 ± 14.2	1.3 ± 3.2	1.461	0.14
Language	70.1 ± 14.0	76.1 ± 15.6	6 ± 8.7	2.807	0.005	0.68
Attention	77.5 ± 19.1	80.1 ± 17.1	2.7 ± 7.8	1.289	0.20
Delayed memory	79.5 ± 18.8	84.6 ± 19.8	5.1 ± 9.0	2.67	0.008	0.51
Beck Depression Inventory score	14.5 ± 10.0	14.1 ± 9.5	−0.4 ± 0.8	1.732	0.08
5 Hz rTMS
RBANS scores
Total	69.1 ± 10.9	76.9 ± 10.6	7.8 ± 5	2.938	0.003	0.99
Immediate memory	69.2 ± 20.0	75.4 ± 21.5	6.2 ± 11.7	1.602	0.11
Visuospatial ability	87.0 ± 13.9	91.0 ± 16.8	4 ± 12.6	0.889	0.37
Language	76.3 ± 4.8	77.7 ± 7.3	1.5 ± 8.8	0.954	0.34
Attention	70.1 ± 19.0	84.6 ± 15.1	14.5 ± 15.1	2.805	0.005	0.41
Delayed memory	75.1 ± 21.1	90.6 ± 16.0	15.5 ± 13	2.713	0.007	0.93
Beck Depression Inventory score	13.0 ± 13.2	8.3 ± 6.5	−4.7 ± 11.4	0.949	0.34
Sham
RBANS scores
Total	65.3 ± 16.1	65.9 ± 16.1	0.6 ± 4.7	0.000	1.000
Immediate memory	61.3 ± 20.0	64.1 ± 23.7	2.7 ± 7.9	1.263	0.21
Visuospatial ability	82.9 ± 15.6	80.1 ± 12.2	−2.8 ± 10.9	0.756	0.45
Language	63.3 ± 18.1	62.7 ± 17.5	−0.6 ± 5.7	0.119	0.91
Attention	76.1 ± 20.8	74.5 ± 22.6	−1.6 ± 7.3	0.77	0.44
Delayed memory	76.1 ± 20.8	67.4 ± 23.1	−8.7 ± 15.4	1.923	0.054
Beck Depression Inventory score	9.2 ± 8.2	7.8 ± 7.6	−1.1 ± 2.2	1.802	0.07

iTBS = intermittent theta burst stimulation; RBANS = Repeatable Battery for the Assessment of Neuropsychological Status; rTMS = repetitive transcranial magnetic stimulation.
↵* Values are expressed as mean ± standard deviation. Wilcoxon signed rank test for intragroup comparison; improvement compared with baseline. Significance levels set at p < 0.05.