Integrative approaches to acupuncture therapies for post-stroke mild cognitive impairment: a systematic review and network meta-analysis

Background Post-stroke mild cognitive impairment (PSMCI) frequently occurs after stroke and substantially restricts patients’ functional restoration and overall quality of life. Acupuncture has been widely adopted as an adjunctive intervention; however, the relative efficacy and safety profiles among different acupuncture modalities for PSMCI have not been clearly established. Objective To assess the comparative effectiveness and safety of multiple acupuncture therapies for treating PSMCI via network meta-analysis. Methods RCTs on acupuncture for PSMCI published from their inception to October 2025 were retrieved from nine databases and four clinical trial registries. Study quality was assessed via the Cochrane risk of bias tool. Meta-analysis was performed with ReviewManager and Stata software. Results In total, 47 RCTs featuring 3,680 participants and 15 types of acupuncture-related interventions were included. Electroacupuncture combined with Moxibustion showed the highest efficacy in improving both MoCA score [MD = 5.42, 95%CI (2.10, 8.74)] and total effective rate. Electroacupuncture plus HBOT [MD = 8.00, 95%CI (5.19, 10.82)] and manual acupuncture plus rTMS [MD = 3.42, 95%CI (0.87, 5.97)] were most effective in improving MMSE. Manual acupuncture plus donepezil [MD = 8.67, 95%CI (5.47, 11.88)] and Electroacupuncture plus cognitive training [MD = −8.09, 95%CI (−10.56, −5.62)] achieved the greatest improvement in Barthel index. Moreover, the adverse events of these interventions were acceptable. Conclusion This study suggested that acupuncture was effective and safe for PSMCI treatment. However, the poor methodological quality and uneven evidence quality of existing studies warrant further rigorously designed trials to confirm our findings. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420251165945.