The effects and mechanisms of acupuncture for post-stroke cognitive impairment: progress and prospects

Abstract

Stroke is one of the important causes of both disability and death worldwide, which is very common in older adults. Post-stroke cognitive impairment (PSCI) is a common secondary damage of stroke, which is the main cause of long-term disability and decreased quality of life in stroke patients, which brings a heavy burden to society and families. Acupuncture, as one of the oldest and widely used worldwide techniques in Chinese medicine, is recommended by the World Health Organization (WHO) as an alternative and complementary strategy for improving stroke care. This review comprehensively summarizes literature from the last 25 years, showing that acupuncture can exert strong beneficial effect on PSCI. The mechanisms of acupuncture on PSCI involves anti-neuronal apoptosis, promoting synaptic plasticity, alleviating central and peripheral inflammatory reactions, and regulating brain energy metabolism disorders (including improving cerebral blood flow, glucose utilization and mitochondrial structure and function, etc.), etc. The effects and mechanisms of acupuncture on PSCI reviewed in this study provides scientific and reliable evidence for acupuncture application for PSCI.

Keywords: acupuncture; post-stroke cognitive impairment; stroke; vascular cognitive impairment; vascular dementia.

FIGURE 1

Post-stroke cognitive impairment (PSCI)-related concept diagram.

FIGURE 2

Mechanisms of acupuncture on PSCI. Factors in blue are upregulated by acupuncture, while factors in green are down-regulated by acupuncture. PSCI, post-stroke cognitive impairment; IS, ischemic stroke; ICH, intracerebral hemorrhage; Bcl-2, B-cell lymphoma 2; NF-κB, nuclear factors-κB; PSD-95, postsynaptic density protein-95; AR, adrenergic receptor; TRPV1, transient receptor potential vanilloid subtype 1; NMDAR, N-methyl-d-aspartate receptor; CaM, calmodulin; CaMKIV, calmodulin-dependent protein kinase type IV; CREB, cyclic adenosine monophosphate response elements binding protein; DA, dopamine; Ach, acetylcholine; 5-HT, 5-hydroxytryptamine; TLRs, Toll like receptors; PAMPs, pathogen associated molecule pattern; MyD88, bone marrow differentiation factor 88; Hspb1, heat-shock protein β1; pERK, phospho-extracellular signal-regulated kinase; CBF, cerebral blood flow; RNS, reactive nitrogen; ROS, reactive oxygen species; NO, nitric oxide; MDA, malondialdehyde; NOS, NO synthase; GSH-Px, glutathione peroxidase; TXNIP, thioredoxin-interacting protein; Trx, thioredoxin.