Do Novel Nonexercise and Nondrug Treatments Improve Global Cognition in Parkinson's Disease Patients? A Systematic Review and Bayesian Analysis.

This Bayesian network meta-analysis method was used to assess the effect of novel treatments on global cognition in patients with Parkinson's disease (PD). We searched randomized controlled trials from PubMed, Cochrane Library, Web of Science and Embase to investigate novel treatments for global PD cognition until April 10, 2024. Effect size measures were standardized mean differences with 95% confidence intervals. We included 13 studies investigating traditional paper-and-pencil cognitive training, modified cognitive training (MCT), repetitive transcranial magnetic stimulation (rTMS), rTMS plus MCT, Mediterranean diet, speech therapy, transcranial direct current stimulation (tDCS) and tDCS plus MCT. Comparisons between novel treatments and the control group revealed the following findings: Mediterranean diet (1.25, 0.74-1.76), rTMS plus MCT (0.82, 0.13-1.52), rTMS (0.42, 0.08-0.76) and MCT (0.34, 0.03-0.66) exhibited statistically significant improvements in global cognition in patients with PD, while the remaining treatments did not reveal significant differences. To conclude, the Mediterranean diet, rTMS, MCTs and rTMS plus MCT could effectively improve global cognition in patients with PD.