Key result
Post-stroke therapies boost global cognition across modalities, though underlying evidence quality remains critically low.
Why the study?
Post-stroke cognitive impairment causes significant disability, yet methodologically robust trials were lacking and uncertainty persisted regarding the benefits and limitations of pharmacological and non-pharmacological interventions.
Do pharmacological and non-pharmacological interventions improve global cognition in adult stroke survivors with post-stroke cognitive impairment?
Systematic Review (n=57,176)
Yes
Do pharmacological and non-pharmacological interventions improve global cognition in adult stroke survivors with post-stroke cognitive impairment?
Answers are grounded in this paper and cite their sources.
Although numerous pharmacological, physical modality, and rehabilitation interventions show statistically significant improvements in global cognition post-stroke, critically low methodological quality of existing systematic reviews and high heterogeneity preclude firm clinical guideline recommendations.
INTRODUCTION: Post-stroke cognitive impairment (PSCI) remains a common problem that can lead to significant disability and dependency. Previous work suggested that methodologically robust trials were lacking and that there is continued uncertainty on the benefits and limitations of pharmacological and non-pharmacological interventions. This umbrella review aims to update and synthesise evidence on pharmacological and non-pharmacological interventions for PSCI. PATIENTS AND METHODS: This review was pre-registered on PROSPERO (CRD42024611909) with searches from 2019 to 2024. Eligible studies were systematic reviews (SRs) of randomised controlled trials (RCTs) evaluating pharmacological or non-pharmacological interventions in adult stroke survivors (≥18 years) of any severity and reporting change in global cognition (eg, Mini-Mental State Examination). AMSTAR2 was used for risk of bias. RESULTS: Of 4889 records identified, 69 SRs (global cognition data from 747 unique RCTs; 57,176 participants) met inclusion criteria. Interventions were grouped into 37 categories including both single (eg, acupuncture, exercise, cognitive rehabilitation) and combined modalities and assessed at categorical level. Most intervention types were associated with statistically significant improvements in global cognition. Substantial heterogeneity and wide prediction intervals indicate that effect sizes may vary considerably across populations and settings. DISCUSSION: This review identifies promising evidence that several interventions may produce clinically meaningful improvements in global cognition post-stroke. However, confidence in this evidence is low: despite a substantial increase in the number of RCTs most included reviews were rated as critically low in quality with methodological limitations. CONCLUSION: Current evidence is insufficient to support firm recommendations for the inclusion of specific interventions in guidance.
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Tang et al. (2026) conducted a systematic review in Post-stroke cognitive impairment (PSCI) in adult stroke survivors (n=57,176). Pharmacological and non-pharmacological interventions (37 categories including physical modalities, rehabilitation, and pharmacological combinations) vs. Placebo, sham stimulation, usual care, or conventional rehabilitation/medical therapy was evaluated on Change in global cognition (assessed via MMSE, MoCA, LOTCA, P300, ACE/ACE-R, RBANS, ADAS-Cog, etc.) (SMD 1.34 (Physical modalities), SMD 0.44 (Rehabilitation), SMD 1.25 (Pharmacological combinations), 95% CI 1.16-1.52). Pharmacological and non-pharmacological interventions improved global cognition post-stroke, though review quality was critically low.
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