Efficacy of Continuous Theta Burst Stimulation on Brain Clearance Recovery in Post-stroke Cognitive Impairment

Abstract Background: Cognitive impairment is a frequent and often debilitating consequence of stroke. This single-blinded randomized controlled trial examined the therapeutic benefits of continuous theta burst stimulation (cTBS) for patients with post-stroke cognitive impairment (PSCI). Methods: Twenty patients with PSCI were randomly and equally allocated to cTBS and sham cTBS groups. Groups received the indicated treatments five consecutive days per week for 2 weeks (10 sessions) plus 10 sessions of computer-assisted cognitive training. The primary outcomes were changes in Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) score and analysis along the perivascular space (ALPS) index. Results: The post-intervention change in ADAS-cog score from baseline was significantly greater in the cTBS group than the sham cTBS group (-7.7 ± 3.8 vs. -3.7 ± 1.5, t = -3.096, P = 0.006). Change in ALPS index from baseline was also greater in the cTBS group (0.182 ± 0.097 vs. 0.093 ± 0.080, t = 2.236, P = 0.038). Conclusion: Continuous theta burst stimulation can improve cognitive outcome and enhance ALPS. Enhanced waste clearance via the glymphatic system induced by cTBS may contribute to improved cognitive function following stroke.Clinical Trial Registration URL: http://www.chictr.org.cn. ChiCTR1800017997. Registered August 25, 2018, retrospectively registered.