A Systematic Review and Meta-Analysis of the Protective Effects of Acupuncture on Cognitive Function and Neuroinflammation During the Peritreatment Period of Neurological Diseases

Background Perioperative and peritreatment cognitive decline and neuroinflammation are common and clinically significant complications in patients with chronic vascular cognitive impairment (VCI), poststroke cognitive impairment (PSCI), and postoperative cognitive dysfunction (POCD). Acupuncture has been proposed as an adjunctive protective strategy, but evidence across disease categories has not been systematically quantified. Objective To evaluate the effects of acupuncture-based interventions on global cognitive function (Mini-Mental State Examination [MMSE], Montreal Cognitive Assessment [MoCA]), POCD incidence, and peripheral/central neuroinflammation biomarkers (interleukin-6 [IL-6], S100 calcium-binding protein beta [S100β]) in adult patients undergoing peritreatment care for chronic or subacute cognitive impairment-related neurological conditions or elective surgery. Acute-phase stroke and intracerebral hemorrhage studies were excluded to maintain scope consistency with the review title. Methods We searched PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases from inception to December 2025. Only randomized controlled trials (RCTs) reporting cognitive function as a primary or coprimary outcome were included. Risk of bias was assessed with Cochrane RoB 2.0. Random-effects models were used for all pooled estimates. Prespecified subgroup analyses by disease category were performed. Publication bias was assessed via funnel plots and Egger's regression test. Results Twelve RCTs ( n = 2004) were included. Acupuncture significantly improved MMSE score (mean difference [MD] = 1.88, 95% confidence interval [CI] [1.52, 2.24], Z = 10.25, P < 0.001; I 2 = 45%; 10 studies) and MoCA score (MD = 2.95, 95% CI [2.50, 3.40], Z = 12.84, P < 0.001; I 2 = 40%; 7 studies). POCD incidence was significantly reduced (OR = 0.26, 95% CI [0.17, 0.40], Z = 7.12, P < 0.001; I 2 = 23%; 4 studies). Peripheral IL-6 decreased by 19.75 pg/mL (95% CI [−24.52, −14.98]; I 2 = 55%; 3 studies), and S100β decreased by 0.58 ng/mL (95% CI [−0.78, −0.38]; I 2 = 28%; 3 studies). Subgroup analysis of MMSE revealed significant between-disease differences ( Q = 11.37, df = 3, P = 0.010), with the largest benefit observed in VCI/VCIND (MD = 3.05) and the smallest in POCD (MD = 1.55); within-subgroup heterogeneity was low (MoCA VCI I 2 = 0%, MoCA PSCI I 2 = 12%). No significant publication bias was detected (Egger's: P = 0.262 for MMSE, P = 0.432 for MoCA). Conclusions The findings suggest that acupuncture may provide clinically meaningful improvements in global cognitive function for patients with chronic PSCI and VCI/VCIND, and substantially reduces POCD incidence in elective surgical populations. Concordant reductions in IL-6 and S100β support an antineuroinflammatory mechanism. Findings should not be extrapolated to acute-phase stroke or intracerebral hemorrhage, which fall outside the scope of the present review. Larger sham-controlled trials with standardized protocols are warranted.