Network meta-analysis of the efficacy and safety of non-pharmacological therapies for post-stroke cognitive impairment
Objective To evaluate the efficacy and safety of a variety of interventions based on non-pharmacological therapies in the treatment of post-stroke cognitive impairment by network meta-analysis.Methods Systematic retrieval of different treatment measures in PubMed.Web of Science,Cochrane Library,MEDLINE,CNKI.VIP,Wanfang Data,and China Biomedical Literature Database for randomised controlled trials on the therapeutic effect of patients with post-stroke cognitive impairment.The search was from inception to October 2023.Screening,quality assessment,and information extraction were carried out according to the literature inclusion exclusion criteria,and data were analysed and mapped using Stata 17.0 and RevMan 5.4.Results This study included 42 randomized controlled trials,involving a total of 2 965 patients with post-stroke cognitive impairment and five non-pharmacological therapies.The results of network meta-analysis showed that in terms of simple intelligence status check scale scores:acupuncture(standardised mean difference[SMD]=1.02,95％CI:0.52-1.53),transcranial magnetic stimulation(SMD=1.03,95％CI:0.43-1.63),transcranial direct current stimulation(SMD=0.79,95％CI:0.18-1.39),and computer-assisted cognitive training(SMD=0.69,95％CI:0.23-1.16)were significantly different from conventional nursing measures(P＜0.05).Ranking results according to the surface under the cumulative ranking(SUCRA)value showed that acupuncture was most likely to be the best non-pharmacological treatment(SUCRA=76.9).In terms of Montreal cognitive scores:transcranial magnetic stimulation(SMD=2.10,95％CI:1.15-3.05)and transcranial direct current stimulation(SMD=1.30,95％CI:0.01-2.59)were significantly different from conventional nursing measures(P＜0.05).In descending order according to SUCRA values were:repetitive transcranial magnetic stimulation,transcranial direct current stimulation,acupuncture,computer-assisted cognitive training,virtual reality technology,and conventional nurse.In terms of the ability to perform daily life scores:acupuncture(SMD=1.44,95％CI:0.86-2.03),transcranial direct current stimulation(SMD=1.32,95％CI:0.58-2.06),and transcranial magnetic stimulation(SMD=0.86,95％CI:0.32-1.40)were significantly different from conventional nursing measures(P＜0.05).Acupuncture(SMD=1.46,95％CI:0.41-2.52)and transcranial direct current stimulation(SMD=1.34,95％CI:0.11-2.57)were significantly different from virtual reality(P＜0.05).The SUCRA ranking results showed that acupuncture(SUCRA=83.3)had the highest likelihood of being the best treatment measure.Conclusion Current studies have shown that acupuncture and transcranial magnetic stimulation are more effective in improving the cognitive function and daily life ability of patients with post-stroke cognitive impairment.In future research,attention should be paid to the improvement of non-pharmacological therapies for the post-stroke cognitive function,and appropriate intervention measures should be selected according to the characteristics of the patient's condition.
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