Effect of Acupuncture on Cognitive Function in Patients With Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis

Abstract

Aims and objective: To investigate the impact of acupuncture on post-stroke cognitive impairment (PSCI).

Background: PSCI is a major barrier to stroke patients' rehabilitation, and acupuncture is one of the treatments. However, the benefit of acupuncture on PSCI is unclear.

Design: A meta-analysis and systematic review of randomized controlled trials (RCTs).

Methods: Up to February 1, 2024, databases in PubMed, MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, VIP, and Wanfang Data were searched. The risk of bias was investigated using the Cochrane Handbook for systematic reviews of treatments. Random-effect and fix-effect models were used to report the effects.

Results: There were 29 randomized clinical trials with 2477 participants included. The findings demonstrated that the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) scores were higher in the acupuncture group than medicine group (mean difference [MD] = 1.74, 95% confidence interval (CI) CI [1.26, 2.23], I² = 59%, p < 0.01). Compared to medicine group, the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) score exhibited a significant decrease and demonstrated improvement in the acupuncture group. Statistically significant outcomes were observed in the Barthel Index scores and P300 event-related potential (ERP). According to subgroup analysis, acupuncture was superior to conventional therapy for improving cognitive function in PSCI patients at 4 weeks after treatment.

Conclusion: Acupuncture therapy has shown promise in ameliorating cognitive deficits and enhancing daily functional abilities in individuals diagnosed with PSCI. But future research should focus on the duration and implement large sample, high-quality RCTs.

Relevance to clinical practice: Clinical workers in practical clinical work can select appropriate acupoints according to the actual conditions of patients, as well as confirm the treatment course of PSCI patients, while paying attention to observing and evaluating the therapeutic efficacy of acupuncture, to improve the health outcomes of patients in a patient-centered way.

Keywords: acupuncture; cognitive function; meta‐analysis; post‐stroke cognitive impairment; systemic review.

FIGURE 1

Preferred reporting items for systematic reviews and meta‐analyses (PRISMA) flow diagram of the literature inclusion process. PSCI, post‐stroke cognitive impairment; RCT, randomized controlled trial.

FIGURE 2

Risk of bias assessment of the included articles: (A) risk of bias graph; (B) risk of bias summary.

FIGURE 3

Forest plot of cognition in patients with PSCI: (A) forest plot of Montreal Cognitive Assessment (MoCA); (B) forest plot of Mini‐Mental State Examination (MMSE); (C) forest plot of P300 latency; (D) forest plot of P300 amplitude; (E) forest plot of Loewenstein Occupational Therapy Cognitive Assessment (LOTCA). CI, confidence interval; PSCI, post‐stroke cognitive impairment.

FIGURE 4

Subgroup analysis of changes in Montreal Cognitive Assessment. (A) subgroup analysis of different intervention methods; (B) subgroup analysis of different intervention times. CI, confidence interval.

FIGURE 5

Subgroup analysis of different intervention times of changes in Mini‐Mental State Examination. CI, confidence interval.

FIGURE 6

Forest plot of Barthel Index in patients with post‐stroke cognitive impairment.

FIGURE 7

The funnel plot of the Montreal Cognitive Assessment and Mini‐Mental State Examination: (A) funnel plot of MoCA; (B) funnel plot of MMSE.