Repetitive Transcranial Magnetic Stimulation for Elderly Patients with Cognitive Impairment: A Meta Analysis of Randomized Controlled Trials
ZhiGang Cao*, Mi Yang
Department of Neurology, Sichuan Taikang Hospital, Chengdu, Sichuan, China
Objective: This meta-analysis of randomized controlled trials (RCTs) examines the effects of repetitive transcranial magnetic stimulation (rTMS) on cognitive function in elderly patients (aged 55 or older) and identifies potential influencing factors.
Methods: Searches of Embase, Web of Science, Cochrane Library, PubMed, CNKI, and Wanfang identified RCT studies evaluating the Impact of rTMS on cognition in older adults. The search spanned the period from the database's inception to 15 December 2024. Following the study identification and data extraction by two independent reviewers, the risk of bias was assessed with the Cochrane RoB tool. Data synthesis and subgroup analysis were performed via SMD, WMD, and 95% CIs to evaluate the effects of rTMS and its influencing factors. The review protocol was prospectively registered in PROSPERO (CRD42020187336)
Results: A total of 13 studies, including 14 trials with 655 patients, were analyzed. Compared to the control group, real rTMS significantly improved cognition in elderly patients (Global Cognitive Function: SMD, 0.56;95% CI 0.33,0.79; p<0.0001; MMSE: WMD,2.04;95% CI 1.54,2.53; p<0.0001; ADAS-Cog: WMD, -2.59;95% CI -3.63, -1.54; p<0.0001; MoCA: WMD,2.46; 95% CI 1.47, 3.45; p<0.0001). Subgroup analysis revealed that participants receiving rTMS combined with cognitive training demonstrated more significant improvements than those receiving rTMS alone (WMD: 0.51; 95% CI: 0.26,0.76; p < 0.0001). Additionally, other subgroup analyses—including rTMS stimulating sites (multiple vs. single sites), education years (≥10 vs. <10 years), and rTMS frequency (5/10/20 Hz vs. iTBS (intermittent theta-burst stimulation)—showed no significant differences (p > 0.05).
Conclusion: Both standalone rTMS and rTMS combined with cognitive training—which varied across studies and included both computerized paradigms (face-name associative memory training, mirror neuron system therapy, VR interactions) and individualized one-on-one training—demonstrated significant efficacy in improving global cognitive function in elderly patients with mild to moderate symptoms. As a safe and well-tolerated intervention, rTMS demonstrates considerable potential for reliable clinical application.
DOI: 10.29245/2572.942X/2025/4.1326 View / Download PdfPure cerebellitis: A Case Report on Rare Presentation of Scrub Typhus Fever
Aditi Mohan*, Kalam Singh Butola
Veer Chandra Singh Garhwali Government Institute of Medical Sciences and Research, Uttarakhand, India
Scrub typhus is an infectious rickettsial disease caused by the bacterium Orientia tsutsugamushi, transmitted through the bite of chigger mites. This illness can manifest in various ways, ranging from a simple tropical fever to complex multi-organ dysfunction, encompassing acute liver failure, renal failure, acute respiratory distress syndrome, myocarditis, septic cardiomyopathies, secondary hemophagocytic lymphohistiocytosis (HLH), and disseminated intravascular coagulation (DIC) among others. While neurological complications can arise in scrub typhus, the exact frequency remains uncertain. One rarely reported neurological complication associated with this condition is cerebellitis.
In this specific case report, we detail the clinical experience of a 25-year-old woman who presented with fever and substantial cerebellar dysfunction and was diagnosed with scrub typhus based on serological test ,specifically an IgM enzyme-linked immunosorbent assay (ELISA) blood test. Notably, her MRI scan and blood investigations revealed no abnormalities, and she responded well to antimicrobial and steroid therapy, ultimately experiencing a full recovery without any complications.
DOI: 10.29245/2572.942X/2025/3.1321 View / Download PdfNeurodegenerative Disease as A Potential Consequence of Aging in Cystic Fibrosis
Danica F. Patton-Parfyonov, Thomas J. Kelley*
Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, USA
New therapies in cystic fibrosis (CF) have made a significant impact on the overall health of people with CF (pwCF). Because of the success of these therapies, it is anticipated that lifespans of pwCF will significantly increase. For the first time, the impacts of aging with CF need to be considered. Until now, relatively little has been done to evaluate neurological health in pwCF. In this review, we consider evidence for a potential prevalence of neurodegenerative disease in CF including our recent study examining tauopathy in an aged CF mouse model.
DOI: 10.29245/2572.942X/2025/3.1323 View / Download PdfPredictors of Hemorrhagic Transformation in Acute Ischemic Stroke Patients in Addis Ababa, Ethiopia: A Multicenter Retrospective Study
Betelhem Molla Dumessa1*, Tsion Haile Woldemariam2*, Mohammed Kedir Shukri1, Mihiret Legese Nadew1, Kalkidan Molla Tegegne2, Mahlet Minwuyelet Dagne2, Asonya Abera Akuma2, Melat Teklegiorgis Biru1
1Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
2Arba Minch University College of Medicine and Health Sciences, Arba Minch, Ethiopia
Background: Ischemic stroke is a major global cause of morbidity and mortality, disproportionately affecting low- and middle-income countries. Hemorrhagic transformation (HT) is a frequent and serious complication of acute ischemic stroke, occurring in 3.2% to 43.3% of patients and associated with increased mortality. Identifying predictors of HT is essential to improving patient outcomes.
Objective: To determine clinical and demographic predictors of hemorrhagic transformation in acute ischemic stroke patients admitted to three major hospitals in Addis Ababa, Ethiopia.
Methods: A retrospective case-control study was conducted on 270 adult inpatients with acute ischemic stroke at Saint Paul Hospital Millennium Medical College, Zewditu Memorial Hospital, and Tikur Anbessa Specialized Hospital between June 2019 and July 2022. Data were analyzed using SPSS version 26.0. Bivariate and multivariate logistic regression analyses identified associations between HT and potential predictors. Statistical significance was set at p < 0.05.
Results: The mean age was 61.2 years, with 37.8% aged 61–70 years. History of diabetes mellitus increased the risk of HT by 5.4 times (AOR=5.4, 95% CI: 2.35–12.31, p<0.001), and stress hyperglycemia increased risk by 12.2 times (AOR=12.2, 95% CI: 2.30–65.12, p=0.003). Previous stroke or transient ischemic attack raised risk 3.7-fold (AOR=3.7, 95% CI: 1.57–8.86, p=0.003). Warfarin therapy was associated with a 13.1-fold increased risk (AOR=13.1, 95% CI: 6.91–131.62, p<0.001), and concurrent use of multiple anticoagulants increased risk 3.8-fold (AOR=3.8, 95% CI: 1.55–9.57, p=0.004).
Conclusion: Anticoagulant therapy, stress hyperglycemia, prior stroke, and diabetes mellitus are significant independent predictors of hemorrhagic transformation in acute ischemic stroke. Emphasizing guideline-based management and addressing modifiable risk factors may reduce HT incidence and improve outcomes.
DOI: 10.29245/2572.942X/2025/3.1318 View / Download PdfDopamine Toxicity in Parkinson’s Disease: Impact of Altered Protein-Protein Interactions
Tapasi Roy1*, Snehasikta Swarnakar2
1Acharya Jagadish Chandra Bose College, Kolkata, West Bengal, India
2CSIR-Indian Institute of Chemical Biology, Infectious Diseases and Immunology Division, Kolkata, West Bengal, India
Parkinson’s disease (PD) is a frequently occurring neurodegenerative condition. The onset of the disease is due to selective loss of dopaminergic neurons, causing increased dopamine (DA) in the neuronal microenvironment. Neurotoxicity due to such increased DA is the outcome of reactive oxygen species (ROS) and oxidative products of DA. Proteins like alpha-synuclein, ubiquitin carboxyl-terminal hydrolase L1 (UCHL1), Cofilin and matrix metalloproteinases 9 (MMP9) are few known key regulators in PD. The impact of elevated DA on these protein-protein interactions plays a crucial role in disease progression. Further, DA toxicity leads to alteration of protein-protein interactions and degrades neuronal cytoskeleton, leading to cell death. This review suggests a novel arena in PD treatment by targeting DA altered protein-protein interactions.
DOI: 10.29245/2572.942X/2025/3.1317 View / Download Pdf