Traditional Chinese Medicine for Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis

Abstract

Background: Post-stroke cognitive impairment (PSCI) affects more than one-third of stroke patients, and causes much greater harm to long-term function than the initial brain damage. No conventional Western medications have shown convincing clinical effectiveness for treating PSCI. Research shows that Traditional Chinese medicine (TCM) can improve cognitive function in patients. However, the clinical efficacy and safety remain controversial. The aim of this study was to examine the effectiveness and harmful effects of TCMs in the treatment of PSCI.Method: We searched seven databases and two clinical registration websites for randomized controlled trials (RCTs). The revised Cochrane risk of bias tool (RoB 2.0) was used to evaluate the methodological quality and RevMan 5.4 was used for data analysis. This study has been submitted to PROSPERO with registration number is CRD42020149299.Results: We included 34 studies in this review. The results of this study showed that TCM adjuvant therapy improved scores on the MoCA [MD = 2.55, 95% CI (1.56, 3.53), p < 0.00001; MD = 3.07, 95% CI (1.98, 4.17), p < 0.00001 at treatment duration of <3 and 3 months, respectively], MMSE [MD = 2.55, 95% CI (1.99, 3.10), p < 0.00001; MD = 2.53, 95% CI (1.59, 3.47), p < 0.00001; MD = 2.91, 95% CI (1.26, 4.56), p = 0.0006; MD = 3.11, 95% CI (−0.04, 6.27), p = 0.05 at treatment duration of <3, 3, 4, and 6 months, respectively], and BI [MD = 7.34, 95% CI (3.83, 10.85), p < 0.0001; MD = 8.98, 95% CI (4.76, 13.21), p < 0.0001 at treatment duration of <3 and 3 months, respectively] and reduced scores on the ADL (MD = −8.64, 95% CI (−9.83, −7.45), p < 0.00001; MD = −2.00, 95% CI (−2.94, −1.06), p < 0.0001 at treatment duration of 3 and 4 months, respectively], NIHSS [MD = −2.48, 95% CI (−4.97, 0.00), p = 0.05; MD = −3.81, 95% CI (−6.21, −1.40), p = 0.002 at treatment duration of <3 and 3 months, respectively], and CSS [MD = −2.47, 95% CI (−3.49, −1.45), p < 0.00001 at a treatment duration of 3 months]. No serious adverse reactions were observed.Conclusion: Despite the significant positive results, the present evidence supports, to a limited extent because of the methodological flaws and herbal heterogeneity, that TCM adjuvant therapy can be used for patients with PSCI. While, further rigorous RCTs are warranted to confirm the efficacy and safety of TCM.Systematic Review Registration:https://www.crd.york.ac.uk/prospero, identifier CRD42020149299.

Excitatory Repetitive Transcranial Magnetic Stimulation Over the Ipsilesional Hemisphere for Upper Limb Motor Function After Stroke: A Systematic Review and Meta-Analysis

“…In addition, the motor evoked potential (MEP) amplitude was used to assess cortical excitability ( 38 ). The Review Manager Version 5.4 was used for all analyses ( 39 ). When different scales were used for outcome measures and the outcome was a continuous variable, effect size would be reported as standardized mean differences (SMD) with 95% confidence intervals (CI) instead of mean differences (MD).…”

Post-stroke cognitive impairment and synaptic plasticity: A review about the mechanisms and Chinese herbal drugs strategies

“…Among these, Chinese herbal drugs, as a class of natural medicinal products based on the theory of traditional Chinese medicine, have great potential to improve synaptic plasticity thus improving cognitive function (Bordet et al, 2017). In our previous research, python language data was used to mine the medication rules of Chinese herbal drugs in the treatment of 10.3389/fnins.2023.1123817 PSCI and the 38 Chinese herbal drugs that were used more than 10 times were excavated (Shen et al, 2022). After scrutinizing the literature about the mechanism of the above 38 Chinese herbal drugs, we summarized the Chinese herbal drugs that reverse cognitive impairment by improving synaptic plasticity.…”

“…Furthermore, β-asarone can inhibit phosphorylation of the JNK signaling pathway in hippocampal neurons, upregulate Bcl-2 expression, and downregulate caspase-3 expression, thereby playing an antiapoptotic role in hippocampal neurons. Using Python software to analyze the prescription of traditional Chinese medicine in the treatment of PSCI, Acorus tatarinowii Schott was found to be the most clinically applied natural medicine (Shen et al, 2022).…”

“…Furthermore, Chinese herbal drugs, as a class of natural medicinal products based on the theory of traditional Chinese medicine, are widely used in Asia and play an important role in improving cognitive function in patients with PSCI. In our previous research, python language data was used to optimize and integrate the medication rules of Chinese herbal drugs in the clinical treatment of PSCI, and 214 Chinese herbal drugs with a total frequency of 1,685 times were found (Shen et al, 2022). However, the mechanism of these Chinese herbal drugs in treating PSCI still needs to be further explored and summarized.…”

Network Pharmacology-based Analysis of the Effects of Huangqi Guizhi Wuwu Decoction on Ischemic Stroke*

“…With the change in lifestyle in the new era, the incidence of stroke is getting higher and higher, and the role of TCM in prevention and treatment is becoming more and more critical (Shen et al, 2022). Applying classical prescriptions in modern medical treatment to better guide clinical practice requires in-depth research on its therapeutic targets and pathways.…”