Comparative efficacy of non-pharmacological interventions for post-stroke cognitive impairment: a systematic review...

Post-stroke cognitive impairment (PSCI) substantially diminishes quality of life and functional independence in stroke survivors. Various non-pharmacological interventions have been proposed to improve cognitive and functional outcomes; however, their relative effectiveness remains uncertain.

A network meta-analysis of 23 RCTs (1,723 participants) evaluated seven non-drug therapies, including computer-based cognitive training (CCT), transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), acupuncture, exercise, and their combinations. Primary and secondary outcomes were MoCA and MBI scores, respectively.

Regarding MoCA scores, the most effective intervention was CCT combined with tDCS (mean difference vs. control: 6.67; 95% CrI: 1.20-12.13), followed by acupuncture combined with rTMS (6.59; 95% CrI: 4.34-8.84) and rTMS alone (4.26; 95% CrI: 2.65-5.88). SUCRA rankings indicated that CCT + tDCS and acupuncture + rTMS had the highest probabilities of being the most effective treatments. For MBI scores, tDCS (8.41; 95% CrI: 4.50-12.32), exercise rehabilitation (6.87; 95% CrI: 4.92-8.82), and CCT (6.62; 95% CrI: 3.84-9.39) demonstrated the greatest improvements compared to control. Funnel plots revealed no significant publication bias, and contribution plots supported the stability of the network geometry.

Among non-pharmacological approaches for PSCI, combined CCT and tDCS produced the most consistent cognitive improvements, while tDCS and exercise rehabilitation yielded the most pronounced gains in functional recovery. These findings support the clinical integration of multimodal brain stimulation and cognitive rehabilitation strategies in the management of PSCI.