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. 2024 Jun 4:15:1327065.
doi: 10.3389/fneur.2024.1327065. eCollection 2024.

Network meta-analysis of non-pharmacological interventions for cognitive impairment after an ischemic stroke

Guangming Yang  1 , Liyun Guo  1 , Yuan Zhang  1 , Shan Li  1
Affiliations

Network meta-analysis of non-pharmacological interventions for cognitive impairment after an ischemic stroke

Guangming Yang et al. Front Neurol. .

Abstract

Objective: This study aims to evaluate the effectiveness of non-pharmacological interventions in improving cognitive function in patients with ischemic stroke through network meta-analysis.

Methods: We searched databases including the Cochrane Library, PubMed, EmBase, and Web of Science for randomized controlled trials (RCTs) on non-pharmacological treatments to improve cognitive impairment following ischemic stroke. The publication date was up to 15 March 2023. Due to the insufficiency of included studies, supplementary searches for high-quality Chinese literature were performed in databases such as CNKI, WanFang Data, and VIP Chinese Science Journals Database. Two reviewers independently went through the literature, extracted data, and assessed the risk of bias in the included studies using the risk of bias assessment tool recommended by the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. By utilizing R 4.2.3 RStudio software and the GeMTC package, a Bayesian network meta-analysis was conducted to assess the improvement in Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores under a variety of non-pharmacological interventions.

Results: A total of 22 RCTs involving 2,111 patients and 14 different non-pharmacological treatments were included. These interventions were transcranial direct current stimulation (tDCS), reminiscence therapy (RT), remote ischemic conditioning (RIC), physical fitness training (PFT), intensive patient care program (IPCP), moderate-intensity continuous training + high-intensity interval training (MICT + HIIT), medium intensity continuous training (MICT), grip training (GT), acupuncture, cognitive behavioral therapy (CBT), cognitive rehabilitation training (CRT), high pressure oxygen (HPO), moxibustion, and repetitive transcranial magnetic stimulation (rTMS). The results of the network meta-analysis indicated that rTMS had the highest likelihood of being the most effective intervention for improving MMSE and MoCA scores.

Conclusion: The evidence from this study suggests that rTMS holds promise for improving MMSE and MoCA scores in patients with cognitive impairment following ischemic stroke. However, further high-quality research is needed to confirm and validate this finding.

Keywords: cognitive impairment; ischemic stroke; network meta-analysis; non-pharmacological interventions; randomized controlled trials.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Literature search flow.
Figure 2
Figure 2
The network relationships of outcome measures (A) MMSE, (B) MoCA.
Figure 3
Figure 3
Bias risk assessment chart.
Figure 4
Figure 4
Randomized controlled trial (A) RCT of MMSE, (B) RCT of MoCA; (C) line chart of MMSE, (D) line chart of MoCA; (E) funnel plot of MMSE, and (F) funnel plot of MoCA.
See this image and copyright information in PMC

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