Integrative neurobiological mechanisms of acupuncture in post-stroke cognitive impairment: from neurotransmission to brain network remodeling

Post-stroke cognitive impairment (PSCI) is a prevalent sequela of stroke that severely limits recovery and quality of life. Accumulating evidence indicates that acupuncture exerts significant neuroprotective and cognitive-enhancing effects in PSCI; however, the underlying mechanisms remain fragmented across molecular, cellular, and systems levels. This review proposes an integrative neurobiological framework linking neurotransmission, neuroinflammation, neurotrophic signaling, and brain network remodeling to explain how acupuncture promotes neurorepair and cognitive restoration after stroke. We systematically summarized recent clinical and experimental findings from 2001 to 2025 and categorized the converging mechanisms into five inter-related dimensions: (1) regulation of neurotransmitters and synaptic plasticity; (2) anti-inflammatory and immune modulation; (3) anti-oxidative stress and anti-apoptotic actions; (4) up-regulation of BDNF-related pathways and neurotrophic signaling; and (5) enhancement of neurogenesis and reconstruction of brain functional networks. Collectively, these multimodal effects form a systems-level cascade through which acupuncture may facilitate neuroplastic remodeling and cognitive recovery. Current challenges include heterogeneity of study design, insufficient multi-omics validation, and limited longitudinal imaging evidence. Future research should integrate molecular biomarkers, neuroimaging, and clinical outcomes to verify this multi-layered mechanistic framework and to guide precision acupuncture protocols for PSCI rehabilitation.