Advances in understanding the mitochondrial mechanisms underlying acupuncture therapy for post-stroke cognitive impairment

Post-stroke cognitive impairment (PSCI) is a prevalent complication among stroke survivors. The core pathology of PSCI involves mitochondrial dysfunction. This review proposes that acupuncture may act as a multi-target regulator of mitochondrial homeostasis, potentially ameliorating PSCI through mechanisms such as improving core mitochondrial functions, including alleviating oxidative stress, correcting energy metabolism disorders, reducing calcium overload, stabilizing mitochondrial membrane potential (MMP), and repairing mitochondrial ultrastructure, regulating the mitochondrial quality control (MQC) system, mainly manifested in the bidirectional regulation of mitophagy, and inhibiting downstream pathological responses (neuroinflammation and apoptosis). However, high-quality clinical evidence establishing a causal link directly demonstrating that acupuncture improves PSCI by modulating mitochondrial function is extremely scarce. Clinical translation faces challenges including a lack of assessment tools and significant heterogeneity in treatment protocols. Future rigorously designed human studies are urgently needed to validate this mechanistic pathway and explore its translational potential in protocol optimization and combination therapies in PSCI patients.