The efficacy and safety of post-stroke cognitive impairment therapies: an umbrella review

Yongbiao Li; Ruyi Cui; Shaobo Liu; Zhiping Qin; Wenjing Sun; Yong Cheng; Qingshan Liu

doi:10.3389/fphar.2023.1207075

The efficacy and safety of post-stroke cognitive impairment therapies: an umbrella review

Front Pharmacol. 2023 Aug 24:14:1207075. doi: 10.3389/fphar.2023.1207075. eCollection 2023.

Authors

Yongbiao Li¹, Ruyi Cui², Shaobo Liu¹, Zhiping Qin¹, Wenjing Sun¹, Yong Cheng^{1

3

4}, Qingshan Liu¹

Affiliations

¹ Key Laboratory of Ethnomedicine of Ministry of Education, School of Pharmacy, Center on Translational Neuroscience, Minzu University of China, Beijing, China.
² Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China.
³ College of Life and Environmental Sciences, Minzu University of China, Beijing, China.
⁴ Institute of National Security, Minzu University of China, Beijing, China.

Abstract

Background: Stroke survivors are at significantly increased risk of cognitive impairment, which affects patients' independence of activities of daily living (ADLs), social engagement, and neurological function deficit. Many studies have been done to evaluate the efficacy and safety of post-stroke cognitive impairment (PSCI) treatment, and due to the largely inconsistent clinical data, there is a need to summarize and analyze the published clinical research data in this area. Objective: An umbrella review was performed to evaluate the efficacy and safety of PSCI therapies. Methods: Three independent authors searched for meta-analyses and systematic reviews on PubMed, the Cochrane Library, and the Web of Science to address this issue. We examined ADL and Barthel index (BI), Montreal Cognitive Assessment (MoCA), neurological function deficit as efficacy endpoints, and the incidence of adverse events as safety profiles. Results: In all, 312 studies from 19 eligible publications were included in the umbrella review. The results showed that angiotensin-converting enzyme inhibitors (ACEI) and N-methyl-D-aspartate (NMDA) antagonists, cell therapies, acupuncture, and EGB76 can improve the MoCA and ADL, and the adverse effects were mild for the treatment of PSCI. Moreover, Vinpocetine, Oxiracetam, Citicoline, thrombolytic therapy, Actovegin, DL-3-n-Butylphthalide, and Nimodipine showed adverse events or low article quality in patients with PSCI. However, the research evidence is not exact and further research is needed. Conclusion: Our study demonstrated that ACEI inhibitors (Donepezil) and NMDA antagonists (Memantine), EGB761, and acupuncture are the ADL and BI, MoCA, and neurological function deficit medication/therapy, respectively, for patients with PSCI. Clinical Trial Registration: https://inplasy.com/inplasy-2022-11-0139/; Identifier: INPLASY2022110139.

Keywords: clinical trial; neurological functional; post-stroke cognitive impairment; systematic review; umbrella review.

Publication types

Systematic Review

Grants and funding

This study was supported by the National Natural Science Foundation of China (82071676 and 82174085) and the High-Level Hospital Development Program for Foshan “Climbing” Project (BZKY2022054).