Efficacy and safety of electroacupuncture in the treatment of post-stroke cognitive impairment: a systematic review and meta-analysis.

Objective: The objective of this research was to assess whether electroacupuncture is an effective and safe intervention for post-stroke cognitive impairment (PSCI). Methods: Our team systematically searched eight academic databases, including the Cochrane Library, PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (SinoMed), Wanfang Data, and Database of Chinese sci-tech periodicals (VIP). This study conducted a systematic review of randomized controlled trials (RCTs) investigating electroacupuncture for PSCI, covering all available literature from database inception until December 31, 2024. Following a systematic literature screening, data were extracted using Excel. The quality of the included studies was assessed using the Cochrane Risk of Bias tool (RoB 2), and the evidence quality for all outcomes was graded employing the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. All statistical analyses were performed using R software (version 4.0.0) with the 'meta' package. In this study, the Mini-Mental State Examination (MMSE) was used as the primary outcome, while the Montreal Cognitive Assessment (MoCA), the Barthel Index and the Activities of Daily Living (ADL) were used as secondary outcome indicators. Results: This meta-analysis comprised 24 studies with 1769 patients. The results indicated that after 2 to 8 weeks of electroacupuncture treatment, electroacupuncture was more effective in improving PSCI than the control group (cognitive training, hyperbaric oxygen, western medications, repeated transcranial magnetic stimulation (rTMS), conventional acupuncture, sham electroacupuncture, etc.) and significantly improved post-treatment MMSE (MD = 2.62, 95% CI = 1.74-3.51, p < 0.0001, I2 = 95.9%), MoCA (MD = 3.01, 95% CI = 2.12-3.91, p < 0.0001, I2 = 87.0%), Barthel Index (MD = 5.86, 95% CI = 2.71-9.00, p = 0.0017, I2 = 67.7%), and ADL (MD = 5.82, 95% CI = 0.70-10.94, p = 0.0016, I2 = 84.4%) scale scores in patients with PSCI. Subgroup analyses indicated that stroke type might be a potential source of heterogeneity for the MMSE and Barthel Index, while treatment duration might contribute to heterogeneity in MoCA scores. Sensitivity analyses revealed that the pooled effect sizes for MMSE, MoCA, and Barthel outcomes remained stable without significant fluctuations, suggesting the robustness of these findings. However, the ADL outcome demonstrated lower robustness. Egger's test suggested potential publication bias for the MoCA index (p = 0.0016). Conclusion: This systematic review indicates that electroacupuncture may improve cognitive function in patients with PSCI within a short-term period. However, its long-term efficacy and safety profile require further validation through higher-quality evidence. There is a need for future randomized controlled trials with larger sample sizes, longer durations, and more rigorous methodology to verify these findings. Systematic review registration: PROSPERO registration number CRD420250652626.