Electroacupuncture to improve post-stroke cognitive function and modulate cerebral iron deposition: a randomized controlled trial protocol using MRI

Background Post-stroke cognitive impairment (PSCI) is common and hampers rehabilitation. Dysregulated iron homeostasis and ferroptosis are implicated in PSCI, yet targeted treatments are lacking. Acupuncture may improve cognition, but its early-intervention efficacy and iron-related mechanisms remain unclear. Methods and analysis This single-blind randomized controlled trial will enroll 72 patients with ischemic stroke-related cognitive impairment (IS-CI). Participants will be randomized 1:1 to electroacupuncture (EA) or sham electroacupuncture (sEA) in addition to standard pharmacotherapy and rehabilitation. Participants in the EA group will receive verum stimulation at Baihui (GV20), Sishencong (EX-HN1), Shenting (GV24), and bilateral Neiguan (PC6), along with five adjunct points—Hegu (LI4), Zusanli (ST36), Xuanzhong (GB39), Sanyinjiao (SP6), and Taichong (LR3)—on the affected side. The sEA group will receive sham acupuncture at non-acupoint, non-meridian locations situated 1–2 cun away from the true acupoints. Interventions are delivered 5 times weekly for 4 weeks (20 sessions, 30 min each). The primary outcome is the change in Montreal Cognitive Assessment (MoCA) score from baseline to week 4. Secondary outcomes include Mini-Mental State Examination (MMSE), Modified Barthel Index (MBI), Hamilton Anxiety (HAMA) and Depression (HAMD) scales, Pittsburgh Sleep Quality Index (PSQI), and PSCI incidence at 3-month post-stroke (MoCA