The Effect of Computerized Cognitive Training and Transcranial Direct Current Stimulation on Working Memory Among Post-stroke Individuals: a Systematic Review with Meta-analysis and Meta-regression

Overview

Journal BMC Neurol

Publisher Biomed Central

Specialty Neurology

Date 2024 Sep 4

PMID 39232643

Authors

Csaba Kazinczi

Krisztian Kocsis

Katalin Boross

Mihaly Racsmany

Peter Klivenyi

Laszlo Vecsei

Anita Must

Affiliations

Soon will be listed here.

Abstract

Background: Working memory (WM) impairment is a common phenomenon after stroke; however, its management in rehabilitation is less researched. This systematic review and meta-analysis aimed to provide a quantitative synthesis of the impact of computerised cognitive training (CCT) and transcranial direct current stimulation (tDCS) on WM span in post-stroke individuals.

Methods: The literature search in PubMed, Embase, Scopus, and Cochrane Library focused on randomized controlled trials testing the effect of CCT and tDCS on treated stroke patients as compared to untreated controls. Neuropsychological instruments such as Digit Span Forward/Backward and Visual Span Forward Tests defined the outcome of WM span. After extracting study characteristics and quality assessment using the Cochrane Risk of Bias Tool, we conducted a meta-analysis and meta-regression using standardised mean differences.

Results: The search yielded 4142 articles, nine of which (N = 461) fulfilled the inclusion criteria. In the case of CCT, we found significant improvement in Digit Span Backward Test (Z = 2.65, P = 0.008; 95% CI [0.10, 0.67]) and Visual Span Forward Test performance (Z = 3.05, P = 0.002; 95% CI [0.15, 0.69]), while for tDCS, we could not find a sufficient number of studies for the analysis. Furthermore, no significant moderating factor was found in the meta-regression.

Conclusions: In conclusion, CCT appears to be a suitable choice to enhance WM span performance after stroke. However, further research is needed to investigate the effect of tDCS due to the limited number of studies.

Trial Registration: The meta-analysis was conducted according to PRISMA (Preferred Reporting of Systematic Reviews and Meta-Analyses) standards with a PROSPERO registration protocol (ID: CRD42023387182).

Citing Articles

Effectiveness of Transcranial Magnetic Stimulation on Executive Function, Attention, and Memory in Stroke Patients: A Systematic Review and Meta-Analysis.

Le H, Honma K, Annaka H, Shunxiang S, Murakami T, Hiraoka T Cureus. 2025; 16(12):e75194.

PMID: 39759598 PMC: 11700524. DOI: 10.7759/cureus.75194.

References

Lugtmeijer S, Lammers N, de Haan E, de Leeuw F, Kessels R . Post-Stroke Working Memory Dysfunction: A Meta-Analysis and Systematic Review. Neuropsychol Rev. 2020; 31(1):202-219. PMC: 7889582. DOI: 10.1007/s11065-020-09462-4. View

Cowan N . What are the differences between long-term, short-term, and working memory?. Prog Brain Res. 2008; 169:323-38. PMC: 2657600. DOI: 10.1016/S0079-6123(07)00020-9. View

Zhao Y, Zhang X, Chen X, Wei Y . Neuronal injuries in cerebral infarction and ischemic stroke: From mechanisms to treatment (Review). Int J Mol Med. 2021; 49(2). PMC: 8711586. DOI: 10.3892/ijmm.2021.5070. View

Cumpston M, Li T, Page M, Chandler J, Welch V, Higgins J . Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. 2019; 10:ED000142. PMC: 10284251. DOI: 10.1002/14651858.ED000142. View

Huedo-Medina T, Sanchez-Meca J, Marin-Martinez F, Botella J . Assessing heterogeneity in meta-analysis: Q statistic or I2 index?. Psychol Methods. 2006; 11(2):193-206. DOI: 10.1037/1082-989X.11.2.193. View

Thompson T, Waskom M, Gabrieli J . Intensive Working Memory Training Produces Functional Changes in Large-scale Frontoparietal Networks. J Cogn Neurosci. 2016; 28(4):575-88. PMC: 5724764. DOI: 10.1162/jocn_a_00916. View

Bornheim S, Croisier J, Maquet P, Kaux J . Transcranial direct current stimulation associated with physical-therapy in acute stroke patients - A randomized, triple blind, sham-controlled study. Brain Stimul. 2019; 13(2):329-336. DOI: 10.1016/j.brs.2019.10.019. View

Wilde N, Strauss E, Tulsky D . Memory span on the Wechsler Scales. J Clin Exp Neuropsychol. 2004; 26(4):539-49. DOI: 10.1080/13803390490496605. View

Kinney A, Eakman A, Graham J . Novel Effect Size Interpretation Guidelines and an Evaluation of Statistical Power in Rehabilitation Research. Arch Phys Med Rehabil. 2020; 101(12):2219-2226. DOI: 10.1016/j.apmr.2020.02.017. View

10.

Peeters G, Black I, Gomersall S, Fritschi J, Sweeney A, de Oliveira Y . Behaviour Change Techniques in Computerized Cognitive Training for Cognitively Healthy Older Adults: A Systematic Review. Neuropsychol Rev. 2022; 33(1):238-254. PMC: 9998598. DOI: 10.1007/s11065-022-09537-4. View

11.

Kane M, Conway A, Miura T, Colflesh G . Working memory, attention control, and the N-back task: a question of construct validity. J Exp Psychol Learn Mem Cogn. 2007; 33(3):615-622. DOI: 10.1037/0278-7393.33.3.615. View

12.

Funahashi S . Working Memory in the Prefrontal Cortex. Brain Sci. 2017; 7(5). PMC: 5447931. DOI: 10.3390/brainsci7050049. View

13.

Martin D, Liu R, Alonzo A, Green M, Loo C . Use of transcranial direct current stimulation (tDCS) to enhance cognitive training: effect of timing of stimulation. Exp Brain Res. 2014; 232(10):3345-51. DOI: 10.1007/s00221-014-4022-x. View

14.

Andrews S, Hoy K, Enticott P, Daskalakis Z, Fitzgerald P . Improving working memory: the effect of combining cognitive activity and anodal transcranial direct current stimulation to the left dorsolateral prefrontal cortex. Brain Stimul. 2011; 4(2):84-9. DOI: 10.1016/j.brs.2010.06.004. View

15.

Bikson M, Grossman P, Thomas C, Zannou A, Jiang J, Adnan T . Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016. Brain Stimul. 2016; 9(5):641-661. PMC: 5007190. DOI: 10.1016/j.brs.2016.06.004. View

16.

DerSimonian R, Kacker R . Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials. 2006; 28(2):105-14. DOI: 10.1016/j.cct.2006.04.004. View

17.

Shelton J, Elliott E, Hill B, Calamia M, Gouvier W . A Comparison of Laboratory and Clinical Working Memory Tests and Their Prediction of Fluid Intelligence. Intelligence. 2010; 37(3):283. PMC: 2818304. DOI: 10.1016/j.intell.2008.11.005. View

18.

Redick T, Lindsey D . Complex span and n-back measures of working memory: a meta-analysis. Psychon Bull Rev. 2013; 20(6):1102-13. DOI: 10.3758/s13423-013-0453-9. View

19.

Zhao Q, Wang X, Wang T, Dmytriw A, Zhang X, Yang K . Cognitive rehabilitation interventions after stroke: protocol for a systematic review and meta-analysis of randomized controlled trials. Syst Rev. 2021; 10(1):66. PMC: 7931553. DOI: 10.1186/s13643-021-01607-7. View

20.

De Luca R, Leonardi S, Spadaro L, Russo M, Aragona B, Torrisi M . Improving Cognitive Function in Patients with Stroke: Can Computerized Training Be the Future?. J Stroke Cerebrovasc Dis. 2017; 27(4):1055-1060. DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.008. View