Acupuncture on Post-Stroke Cognitive Impairment: A Systematic Review of Neuroimaging Studies

Shiqi Yang,1,2,* Qiongnan Bao,1– 3,* Wanqi Zhong,1,2 Kexin Wu,1,2 Xinyue Zhang,1,2 Jin Yao,1,2 Ziwen Chen,1,2 Ping Xu,1,2 Zihan Yin,1,2 Fanrong Liang1,2 1School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China; 2Acupuncture Clinical Research Center of Sichuan Province, Chengdu, People’s Republic of China; 3Department of traditional Chinese medicine, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, People’s Republic of China*These authors contributed equally to this workCorrespondence: Fanrong Liang, Email [email protected] Zihan Yin, Email [email protected]: Post-stroke cognitive impairment (PSCI) is a severe central nervous system disorder for which acupuncture demonstrates therapeutic efficacy. Various neuroimaging studies have indicated that acupuncture may exert its effects through modulating central mechanisms. However, owing to the current lack of a systematic summary, this study aimed to integrate the existing evidence.Methods: Two independent reviewers conducted a search across eight databases and other sources, identifying potential neuroimaging trials on acupuncture for PSCI, spanning from the inception of the databases to August 25, 2024. Eligible studies were screened based on predefined inclusion and exclusion criteria, and their methodological quality was assessed.Results: Twelve studies, including 671 participants, utilized manual acupuncture (n = 10), electroacupuncture (n = 1), or a combination of both (n = 1). Neuroimaging tools comprised functional magnetic resonance imaging (n = 7), electroencephalography (n = 2), magnetic resonance spectroscopy (n = 2), and functional near-infrared spectroscopy (n = 1). All studies consistently reported positive effects of acupuncture on patients suffering from PSCI. Changes in brain structure and function resulting from acupuncture are commonly observed in the cingulate cortex, parahippocampal gyrus, prefrontal cortex, and fusiform gyrus. Acupuncture appears to modulate cognition-related networks, including the default mode, central executive, frontoparietal, and salience networks, thereby influencing PSCI.Conclusion: The therapeutic effects of acupuncture on PSCI may be mediated through the regulation of cognition-related brain networks. Yet, these studies remain at an exploratory stage, necessitating a combination of multiple imaging techniques and large, strictly designed multicenter RCTs to validate the neuroimaging findings.Keywords: acupuncture, post-stroke cognitive impairment, systematic review, neuroimaging, mechanism