Efficacy of non-invasive neuromodulation technologies in improving cognitive function and activities of daily living in patients with Alzheimer's disease, Parkinson's disease, and stroke: a systematic review and network meta-analysis.

Most trials reported only short-term outcomes, so it is unclear whether gains last beyond the study period. Many included trials were small, which reduces confidence in the pooled estimates. Stimulation settings varied widely, including frequency, intensity, session length, number of sessions, and treatment target, so the results do not identify one reliable protocol. Patients differed in age, education, ethnicity, and baseline severity, so findings may not apply to all clinic populations. MoCA and MMSE are global screens and may miss specific memory, attention, or executive changes. 7 trials were high risk and 22 had some concerns, mainly from inadequate blinding and allocation concealment. The authors rated most evidence as moderate because of indirectness and imprecision. Most included studies were in English, so relevant non-English trials may be missing. The analysis pooled Alzheimer's, Parkinson's, and stroke together, so it does not identify a disease-specific protocol.

Do not choose theta burst stimulation because it ranked first for cognition. It did not show a clear Modified Barthel Index difference versus sham, and the paper warns that a high rank can still mean minimal clinical advantage.