Determinants of MoCA improvement in post-ischemic stroke patients receiving acupuncture: a retrospective study

Background Acupuncture is commonly integrated into multimodal rehabilitation programs for post-ischemic stroke cognitive impairment (PSCI), but the factors associated with cognitive improvement in this complex treatment context remain unclear. This retrospective study investigated factors associated with cognitive improvement in stroke patients receiving acupuncture as part of a standardized multimodal inpatient rehabilitation program. Methods In this single-center retrospective cohort study, 226 ischemic stroke patients treated with acupuncture between January 2023 and December 2025 were enrolled. Demographic data, clinical characteristics, acupuncture treatment parameters, and laboratory indicators were collected from electronic medical records. Cognitive function was assessed using MoCA, MMSE, LOTCA, MBI, HAMD, HAMA, and PSQI scales. Patients were categorized into improvement (ΔMoCA ≥2) and non-improvement groups. Univariate and multivariate logistic regression analyses were used to identify factors associated with cognitive improvement. Results Among the 226 patients, 148 (65.49%) achieved improvement. After treatment, the improvement group showed significant improvements in MoCA and MMSE scores compared with baseline and the non-improvement group [between-group difference for post-treatment MoCA: 1.59 (95% CI 0.82 to 2.36; p < 0.001); MMSE: 2.44 (95% CI 1.69 to 3.19; p < 0.001)]. Significant improvements were also observed in LOTCA, MBI, HAMD, HAMA, and PSQI scores in the improvement group ( p < 0.001). Univariate analysis identified age, education years, admission NIHSS score, diabetes mellitus, time to acupuncture intervention, treatment frequency, and total treatment course as factors associated with recovery ( p < 0.05). Multivariate analysis demonstrated that advanced age (OR = 1.208, p < 0.001), higher NIHSS score (OR = 1.643, p = 0.001), longer time from stroke onset to acupuncture intervention (OR = 1.162, p = 0.011) and diabetes mellitus (OR = 4.737, p = 0.018) were associated with a lower probability of achieving the ΔMoCA improvement threshold. In contrast, longer education duration (OR = 0.740, p = 0.006), higher treatment frequency (OR = 0.271, p < 0.001), and longer treatment course (OR = 0.248, p < 0.001) were associated with a higher probability of meeting the improvement threshold. However, as treatment frequency and total course were determined during the clinical course rather than at baseline, these associations should be interpreted as exploratory and hypothesis-generating, and do not imply causality. Conclusion In this retrospective cohort of PSCI patients receiving acupuncture within a multimodal inpatient rehabilitation setting, shorter time from stroke onset to acupuncture initiation, higher weekly frequency, and longer treatment duration were exploratory factors associated with a greater likelihood of meeting the predefined ΔMoCA improvement threshold in this cohort. These hypothesis-generating observations may inform the design of future prospective studies and suggest patient characteristics that warrant further investigation. However, given the uncontrolled design, these findings cannot establish acupuncture-specific efficacy and should be considered hypothesis-generating, warranting confirmation through prospective randomized controlled trials.