Acupuncture for Post-Stroke Cognitive Impairment: Mechanisms and Clinical Evidence (2020–2025)

Abstract: Post-stroke cognitive impairment (PSCI), a prevalent and severe sequela following cerebrovascular accidents, impacts over a third of stroke survivors. This condition imposes a substantial socioeconomic burden on healthcare systems and informal caregivers. Acupuncture, a venerable therapeutic modality within traditional Chinese medicine with extensive clinical application, has been acknowledged by the World Health Organization as an adjunctive and complementary therapy for cerebrovascular rehabilitation. This comprehensive review synthesizes contemporary evidence from January 2020 through September 2025, demonstrating significant therapeutic efficacy of acupuncture in ameliorating PSCI. The therapeutic mechanisms underlying acupuncture’s neuroprotective effects encompass modulating NVU (Nerve-vascular unit) functioning (including improving cerebral blood flow and cerebral perfusion, preserving BBB (Blood brain barrier) integrity, and attenuating neuroinflammatory processes), brain network remodeling (including modulating neural-plasticity, brain functional connectivity, excitability of local brain regions and node functions), and modulating cerebral energy metabolism (including enhancing mitochondrial function and glucose utilization). We conclude with critical analysis of translational barriers and prospective research trajectories for acupuncture-based interventions in post-stroke cognitive rehabilitation, establishing foundational frameworks for diversifying therapeutic algorithms and advancing precision medicine approaches in cerebrovascular cognitive recovery. These include: Improving cerebral blood flow and cerebral perfusion, shown with a blood vessel. Preserving blood-brain barrier integrity, depicted with a cross-section of a blood vessel and cells. Attenuating neuroinflammatory processes in the neurovascular unit, illustrated with molecular interactions. Modulating brain functional connectivity and the excitability of local brain regions and node functions, shown with a brain map. Enhancing mitochondrial function, depicted with a mitochondrion and various biochemical processes. Enhancing glucose utilization in the brain, shown with a glucose metabolism pathway. Modulating neural-plasticity, illustrated with synaptic components. At the bottom, acupuncture-related points are shown with needles inserted into the skin, indicating the method of treatment.Diagram showing acupuncture’s effects on post-stroke cognitive impairment through various brain and cellular functions. Keywords: PSCI, acupuncture, blood brain barrier, brain network, mitochondria