Non-pharmacological therapies for the management of the cognitive dysfunctions in post-stroke patients: a systematic review and network meta-analysis

Yali Liu; Yue Liang; Wei Gao; Tianjiao Dai; Lezheng Wang; Xiaoqi Ji; Meng Chen; Supo Zhou; Ying Zou; Xiaofei Sun; Bao Wu

doi:10.1097/PHM.0000000000002435

Non-pharmacological therapies for the management of the cognitive dysfunctions in post-stroke patients: a systematic review and network meta-analysis

Am J Phys Med Rehabil. 2024 Jan 19. doi: 10.1097/PHM.0000000000002435. Online ahead of print.

Authors

Yali Liu¹, Yue Liang², Wei Gao³, Tianjiao Dai, Lezheng Wang³, Xiaoqi Ji⁴, Meng Chen⁵, Supo Zhou³, Ying Zou³, Xiaofei Sun³, Bao Wu

Affiliations

¹ School of Exercise and Health, Shanghai University of Sport, Shanghai, China.
² Department of Quality-Oriented Education, Jangsu Vocational College of Electronics and Information, Huaian, China.
³ School of Health and Rehabilitation, Jiangsu College of Nursing, Huaian, China.
⁴ Department of Chinese Teaching and Research, The Fourth Kaiming Middle School of Huaian, China.
⁵ College of International Education, Jiangsu Vocational College of Finance and Economics, Huaian, China.

PMID: 38261747
DOI: 10.1097/PHM.0000000000002435

Abstract

Objective: To investigate the comparative effects of non-pharmacological therapies for managing global, attention, memory and execution cognitive functions in stroke patients.

Design: We searched PubMed, EMBASE, CINAHL, Cochrane Library, Web of Science, PEDro and Google Scholar for randomized controlled trials (RCTs) that evaluated the effects of non-pharmacological therapies for treating stroke cognitive dysfunctions. We performed a network meta-analysis (NMA) to estimate the mean treatment effect of 95% credible interval (CrI).

Results: 73 RCTs were included in the NMA for evidence syntheses. All therapies had significant effects than control on global cognition in stroke patients. Combined therapy was superior to other therapies for global cognition of all patients (vs cognitive task therapy: 0.71, 95%CrI 0.14 to 1.29; vs exercise: 0.88, 95%CrI 0.31 to 1.45, vs physical modality therapy: 0.77, 95%CrI 0.16 to 1.40). Different therapies have effects on specific cognitive domains in stroke patients.

Conclusions: Our findings suggest that non-pharmacological therapies are effective in improving global cognitive function in stroke patients, with cognitive task therapy, exercise therapy, physical modality therapy, and combined therapy being viable options (most optimal approach: combined therapy). Precise selection of therapies based on the time since stroke onset and specific cognitive domains can further enhance treatment outcomes.