Neuroimaging evidence of acupuncture in cognitive impairment following ischemic stroke: a systematic review

Objective: This review aimed to summarize neuroimaging evidence on the effects of acupuncture in post-ischemic stroke cognitive impairment (PISCI) and to explore its potential neural mechanisms. Methods: A systematic search was conducted across multiple databases, including China National Knowledge Infrastructure (CNKI), SinoMed (China Biology Medicine Disc), the Chinese Scientific Journal Database (VIP), Wanfang Data, PubMed, the Cochrane Library, Embase, and Web of Science. Studies were selected according to inclusion and exclusion criteria. Risk of bias was assessed for all eligible studies. Results: Eight studies met the inclusion criteria. These studies utilized resting-state functional magnetic resonance imaging (rs-fMRI) and magnetic resonance spectroscopy (MRS) to investigate the effects of acupuncture on brain activity and metabolic changes. The neuroimaging findings showed that all studies focused on the sustained effects of acupuncture on brain functional activity. Conclusions: This review provides preliminary neuroimaging evidence supporting the potential benefits of acupuncture for PISCI. The findings suggest that the possible mechanisms of acupuncture for PISCI involve changes in the activity and enhanced functional connectivity of cognition-related brain regions. Additionally, acupuncture may influence brain networks and regulate neurochemical metabolites within cognition-related regions. However, as this field remains in its early stages, further validation is needed. Future studies should focus on well-designed, multicenter randomized controlled trials (RCTs) with large sample sizes and incorporate multiple neuroimaging techniques to better clarify and verify the neural mechanisms of acupuncture in PISCI. Systematic review registration: PROSPERO, identifier: CRD420250652194.