The efficacy and safety of post-stroke cognitive impairment therapies: an umbrella review

Umbrella review of systematic reviews and meta-analyses in stroke survivors with post-stroke cognitive impairment. The review synthesized active-treatment arms across trials and assessed cognitive, neurologic, daily-function, and safety outcomes versus placebo or usual care.

This umbrella review did not test a single supplement regimen; it synthesized multiple active post-stroke cognitive impairment therapies versus placebo or control. Among the supplement-like interventions summarized were citicoline 1 g, DL-3-n-butylphthalide 200 mg, oxiracetam 4.0 g, salvianolate 150 mg, vinpocetine 30-60 mg, and EGB761 200 mg, with dosing and duration varying by underlying study.

Overall, several therapies showed improvements in cognition or function, but the evidence was heterogeneous and not definitive. Reported benefits included NBP improving MMSE by MD 4.89 (95% CI 4.14 to 5.63), citicoline improving NIHSS by MD -1.82 (95% CI -2.25 to -1.40), and salvianolate improving NIHSS by MD -2.42 (95% CI -2.86 to -1.98). Acupuncture, memantine, donepezil, oxiracetam, oxygen, and other regimens also showed positive signals on selected outcomes, and adverse effects were generally mild. No significant adverse-event differences were reported for donepezil, actovegin, galantamine, rivastigmine, vinpocetine, nimodipine, oxygen, or olacetam versus placebo, but the authors concluded that higher-quality long-term studies are still needed.

Evidence was drawn from an umbrella review of heterogeneous therapies, outcomes, and underlying review quality rather than a single standardized intervention. Several comparisons had small sample sizes or inconsistent reporting, some effect estimates were imprecise, and long-term safety data were limited. The authors explicitly noted that the evidence is not exact and that further high-quality research is needed.