Accumulating studies have shown that high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) may improve cognitive dysfunction of the patients with schizophrenia (SCZ), but with inconsistent results. The present study aims to assess the efficacy of different frequencies of neuronavigated rTMS in ameliorating cognitive impairments and alleviating the psychotic symptoms. A total of 120 patients were randomly assigned to 3 groups: 20 Hz rTMS (n = 40), 10 Hz rTMS (n = 40), or sham stimulation (n = 40) for 8 weeks, and then followed up at week 32. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was performed to assess the cognitive functions of the patients at baseline, at the end of week 8, and week 32 follow-up. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS) at baseline and at the end of week 2, week 4, week 6, week 8, and week 32 follow-up. Our results demonstrated that 20 Hz rTMS treatment produced an effective therapeutic benefit on immediate memory of patients with chronic SCZ at week 8, but not in the 10 Hz group. Interestingly, both 10 Hz and 20 Hz rTMS treatments produced delayed effects on cognitive functions at the 6-month follow-up. Moreover, in both 10 Hz rTMS and 20 Hz rTMS, the improvements in RBANS total score were positively correlated with the reduction of PANSS positive subscore at the 6-month follow-up. Stepwise regression analysis identified that the visuospatial/constructional index, immediate memory index, and prolactin at baseline were predictors for the improvement of cognitive impairments in the patients. Our results suggest that add-on HF rTMS could be an effective treatment for cognitive impairments in patients with chronic SCZ, with a delayed effect. Trial registration: clinicaltrials.gov identifier—NCT03774927.

中文翻译：

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高频神经导航rTMS在患有主要阴性症状的慢性精神分裂症患者中的认知增强作用：双盲对照的32周随访研究

越来越多的研究表明，高频（HF）重复经颅磁刺激（rTMS）可以改善精神分裂症（SCZ）患者的认知功能障碍，但结果不一致。本研究旨在评估不同频率的神经导航rTMS在改善认知障碍和缓解精神病症状方面的功效。总共120位患者被随机分为3组：20 Hz rTMS（n = 40），10 Hz rTMS（n = 40）或假刺激（n= 40），持续8周，然后在第32周进行随访。在基线时，第8周末和第32周进行了可重复电池评估神经心理状态（RBANS），以评估患者的认知功能跟进。在基线时以及在第2周，第4周，第6周，第8周和第32周随访时，使用阳性和阴性综合征量表（PANSS）评估精神病症状。我们的结果表明20 Hz rTMS治疗对第8周的慢性SCZ患者的即时记忆产生了有效的治疗益处，但在10 Hz组中则没有。有趣的是，在6个月的随访中，10 Hz和20 Hz rTMS治疗均对认知功能产生延迟的影响。此外，在10 Hz rTMS和20 Hz rTMS中，在6个月的随访中，RBANS总评分的改善与PANSS阳性子评分的减少呈正相关。逐步回归分析确定，基线时的视觉空间/结构指数，即时记忆指数和催乳激素是改善患者认知障碍的预测指标。我们的研究结果表明，附加的HF rTMS可能是治疗慢性SCZ患者认知障碍的有效方法，但效果较差。试用注册：clinicaltrials.gov标识符-NCT03774927。我们的研究结果表明，附加的HF rTMS可能是治疗慢性SCZ患者认知障碍的有效方法，但效果较差。试用注册：clinicaltrials.gov标识符-NCT03774927。我们的研究结果表明，附加的HF rTMS可能是治疗慢性SCZ患者认知障碍的有效方法，但效果较差。试用注册：clinicaltrials.gov标识符-NCT03774927。