Effectiveness of technology-assisted cognitive interventions for post-stroke cognitive impairment: a systematic review and meta-analysis

BACKGROUND: Technology-assisted cognitive interventions are increasingly used for post-stroke cognitive impairment (PSCI), but their comparative effectiveness across modalities remains unclear. METHODS: This systematic review and network meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. The Population, Intervention, Comparator, Outcome (PICO) framework was used to define the review question. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched from inception to 26 April 2025 for randomized controlled trials (RCTs) in adults with PSCI. Global cognition was assessed using the Montreal Cognitive Assessment (MoCA) and/or the Mini-Mental State Examination (MMSE). We estimated mean differences (MDs) with 95% confidence intervals (CIs) and ranked interventions using the surface under the cumulative ranking curve (SUCRA). Risk of bias was assessed using Risk of Bias 2 (RoB 2). RESULTS: Fourteen trials (673 participants) were included. For MoCA (9 trials; 535 participants), basic treatment plus conventional cognitive training (CT) plus virtual reality (VR) improved MoCA compared with basic treatment alone (MD = 5.70; 95% CI: 0.12 to 11.27). SUCRA suggested that basic treatment plus computerized cognitive training (CCT) plus repetitive transcranial magnetic stimulation (rTMS) ranked highest for MoCA (84.1%), followed by basic treatment plus conventional CT plus VR (74.8%). For MMSE (8 trials; 265 participants), basic treatment plus rTMS was superior to basic treatment alone (MD = 4.60; 95% CI: 0.45 to 8.75), and basic treatment plus exergaming was also superior to basic treatment alone (MD = 1.47; 95% CI: 0.04 to 2.90). SUCRA ranked basic treatment plus rTMS highest for MMSE (96.3%), followed by basic treatment plus exergaming (76.3%). CONCLUSIONS: Technology-assisted cognitive interventions added to basic treatment may improve global cognitive function after stroke, although the current evidence remains preliminary and varies across modalities. Larger, rigorously designed RCTs are needed to confirm comparative effectiveness and guide optimal implementation in post-stroke rehabilitation. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD420251066176.