Revolutionizing Cognitive Rehabilitation with Transcranial Direct Current Stimulation: A Novel perspectives in Type 2 Diabetes Mellitus

Background: Mild cognitive impairment (MCI), also referred to as central neuropathy, is considered a new complication of diabetes. It affects approximately $\mathbf{1 0 - 1 5 \%}$ of diabetic individuals, leading to a conversion from cognitive impairment to dementia in some cases. This research aims to assess the effectiveness of transcranial direct current stimulation in treating cognitive impairment. Materials and Methods: This study is a Pre-post experimental design involving 30 diabetic patients diagnosed with cognitive impairment. The study was conducted from September 2022 to December 2022, with recruitment taking place in the diabetic outpatient department of a tertiary care hospital. 200 patients were initially approached, with 30 meeting the inclusion criteria: 35 to 55 years, HbA1c levels between $\mathbf{6. 0 \%}$ to $\mathbf{8. 0} \%$, Montreal Cognitive Assessment scores below 24, and diabetes duration less than 5 years. The participants underwent various outcome assessments, including the Addenbrooke Cognitive Examination scale, Indian version, Montreal Cognitive Assessment, and Stroop test, at two-time points, 0 to 5 weeks apart, with five weekly sessions. Patients with additional health conditions were excluded to minimize potential confounding factors. Results: The study utilized parametric tests, with Student t-tests for the MoCA score and Stroop test, and Wilcoxon signed-rank tests for the ACE-III score, a categorical variable. The results showed an increase in the mean ACE-III score from 42.2 to 48.3, indicating a significant improvement ($\mathbf{p}=\mathbf{0. 0 2}$). Similarly, the mean MoCA score rose from 19.3 to 24.6, showing significant improvement (p=0.03). The mean Stroop test time decreased from 60 seconds ±2 to 8 seconds ±2, demonstrating a significant improvement (p=0.04). Conclusion: The findings suggest that TDCS treatment led to enhancements in memory, visuospatial skills, and concentration. However, there was no notable improvement observed in executive skills and abstract thinking.