The efficacy and safety of post-stroke cognitive impairment therapies: an umbrella review
What this study found
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,…
- Study & population
- Umbrella review of systematic reviews and meta-analyses in stroke survivors with post-stroke cognitive impairment.
- Intervention
- This umbrella review did not test a single supplement regimen; it synthesized multiple active post-stroke cognitive impairment therapies versus placebo or control.
- Key limitation
- Evidence was drawn from an umbrella review of heterogeneous therapies, outcomes, and underlying review quality rather than a single standardized intervention.
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Open PDFOriginal abstract
Background: Stroke survivors are at significantly increased risk of cognitive impairment, which affects patients’ independence of activities of daily living (ADLs), social engagement, and neurological function deficit. Many studies have been done to evaluate the efficacy and safety of post-stroke cognitive impairment (PSCI) treatment, and due to the largely inconsistent clinical data, there is a need to summarize and analyze the published clinical research data in this area. Objective: An umbrella review was performed to evaluate the efficacy and safety of PSCI therapies. Methods: Three independent authors searched for meta-analyses and systematic reviews on PubMed, the Cochrane Library, and the Web of Science to address this issue. We examined ADL and Barthel index (BI), Montreal Cognitive Assessment (MoCA), neurological function deficit as efficacy endpoints, and the incidence of adverse events as safety profiles. Results: In all, 312 studies from 19 eligible publications were included in the umbrella review. The results showed that angiotensin-converting enzyme inhibitors (ACEI) and N-methyl-D-aspartate (NMDA) antagonists, cell therapies, acupuncture, and EGB76 can improve the MoCA and ADL, and the adverse effects were mild for the treatment of PSCI. Moreover, Vinpocetine, Oxiracetam, Citicoline, thrombolytic therapy, Actovegin, DL-3-n-Butylphthalide, and Nimodipine showed adverse events or low article quality in patients with PSCI. However, the research evidence is not exact and further research is needed. Conclusion: Our study demonstrated that ACEI inhibitors (Donepezil) and NMDA antagonists (Memantine), EGB761, and acupuncture are the ADL and BI, MoCA, and neurological function deficit medication/therapy, respectively, for patients with PSCI. Clinical Trial Registration: https://inplasy.com/inplasy-2022-11-0139/; Identifier: INPLASY2022110139.