Safety and Efficacy of Anodal transcranial direct-current stimulation over the Dorsolateral Prefrontal Cortex in Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis
In brief
Anodal brain stimulation raised cognitive scores about 3 points after stroke
Across 23 trials involving 1,326 people, anodal transcranial direct-current stimulation over the prefrontal cortex improved Montreal Cognitive Assessment scores by about 3 points and also improved daily functioning. The results were similar across control groups and stimulation sites, but low study quality and sparse safety reporting leave the size and risks of the benefit uncertain.
- Journal
- Complementary therapies in medicine (Q1)
- Published
- 29 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Song Li, Hong Huo, Dongxia Li, Wenqiang Li, Yunzhe Hu, Ao Wang, et al.
- PMID
- 42957099
- DOI
- 10.1016/j.ctim.2026.103465
Why clinicians should know about it
- Picked for Neurology (clinical) (top studies of the week, 1 November 2026): Meta-analysis tests post-stroke cognitive rehabilitation intervention
Abstract
INTRODUCTION: This meta-analysis evaluated the safety and efficacy of anodal transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) for post-stroke cognitive impairment (PSCI). METHODS: Eight databases were searched from inception to June 7, 2026 for randomized controlled trials (RCTs). Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the revised Cochrane risk-of-bias tool. Meta-analyses were conducted using Stata version 18, with subgroups stratified by control type and stimulation site. RESULTS: Twenty-three RCTs involving 1326 participants were included. Anodal tDCS over the DLPFC significantly improved global cognitive screening performance: Clinical Efficacy (odds ratio [OR] = 1.37, 95% confidence interval [CI]: 1.01-1.85, P =0.043), Montreal Cognitive Assessment (MoCA) score (weighted mean difference [WMD] = 3.17, 95% CI: 2.53-3.80, P = 0.000), and Mini-Mental State Examination (MMSE) score (WMD = 2.52, 95% CI: 1.81-3.22, P = 0.001). Subgroup analyses demonstrated superiority of active tDCS regardless of control condition: rehabilitation therapy (RT) plus sham tDCS (MoCA: WMD = 2.45, 95% CI: 1.60-3.30; MMSE: WMD = 2.40, 95% CI: 0.97-3.83) and RT alone (MoCA: WMD = 3.47, 95% CI: 2.81-4.12; MMSE: WMD = 2.72, 95% CI: 2.12-3.32). Benefits were also consistent across stimulation of the affected hemisphere (MoCA: WMD = 2.88, 95% CI: 2.05-3.71; MMSE: WMD = 2.59, 95% CI: 1.50-3.68) and the left hemisphere (MoCA: WMD = 3.42, 95% CI: 2.47-4.38; MMSE: WMD = 2.48, 95% CI: 1.45-3.51). Activities of daily living (ADL) measured by the Modified Barthel Index (MBI) also improved significantly (WMD = 10.75, 95% CI: 8.67-12.84, P = 0.000), with benefits maintained across all subgroups: RT plus sham tDCS (WMD = 11.18, 95% CI: 8.76-13.60), RT alone (WMD = 10.49, 95% CI: 7.67-13.32), affected hemisphere (WMD = 11.37, 95% CI: 7.83-14.91), and left hemisphere (WMD = 10.06, 95% CI: 8.00-12.13). Safety outcomes were infrequently reported. CONCLUSIONS: Anodal tDCS over the DLPFC may improve global cognitive screening performance and ADL in PSCI patients, yet low methodological quality and inadequate safety reporting limit the current evidence. Further high-quality RCTs with rigorous adverse event monitoring are warranted.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.