Remotely supervised (RS) transcranial direct current stimulation (tDCS) appears to be viable and safe for post-stroke cognitive rehabilitation in chronic stroke patients with moderate cognitive decline, as reported in a study.

The study included 26 patients with chronic stroke and cognitive impairment (Korean version of the Montreal Cognitive Assessment [K-MoCA] score <26). They were randomly assigned to groups that received real or sham RS-tDCS groups with concurrent computerized cognitive training.

TDCS was applied by patients and caregivers themselves. A training was conducted beforehand to ensure correct application. Treatment was conducted 5 days a week for 4 weeks.

Researchers evaluated several cognition tests including K-MoCA, Korean version of the Dementia Rating Scale-2, Korean-Boston Naming Test, Trail Making Test, Go/No Go, and Controlled Oral Word Association Test at the end of the training sessions and 1 month later. They used repeated-measures ANOVA to compare the outcomes between the groups and within each group. The adherence rate of the appropriate RS-tDCS session was also assessed.

Within-group comparisons showed that the real group, but not the sham group, achieved significant improvement in K-MoCA (p=0.004 and p=0.132, respectively). The treatment effect of RS-tDCS was more pronounced in patients with lower baseline K-MoCA (K-MoCA 10–17: p=0.001 in the real group vs p=0.835 in the sham group; K-MoCA 18–25: p=0.060 vs p=0.064, respectively), as well as those with left hemispheric lesions (left: p=0.010 vs p=0.454; right: p=0.106 vs p=0.128).

Comparison between groups likewise revealed a significant between-group difference in K-MoCA in the lower baseline K-MoCA subgroup, in favour of the real RS-tDCS intervention (K-MoCA 10–17: ptime×group=0.048). This difference was not seen in other cognitive tests.

Successful application of RS-tDCS had a high adherence rate at 98.4 percent, and no serious adverse effects were documented.