Effectiveness and safety of skull base-peripheral acupuncture for post-stroke cognitive impairment: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE: To evaluate the efficacy and safety of skull base-peripheral (SBP) acupuncture in patients with post-stroke cognitive impairment (PSCI). METHODS: We searched eight Chinese and English databases from inception to July 2025 for randomized controlled trials (RCTs) comparing SBP acupuncture with a control (no or sham acupuncture) in PSCI patients. Two reviewers independently screened studies, extracted data, and assessed outcomes including clinical effective rate, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and activities of daily living (ADL). Data were analyzed using RevMan 5.3 and STATA 18. RESULTS: Twenty-four RCTs involving 1,962 patients were included. Meta-analysis showed that SBP acupuncture was significantly superior to control in improving clinical effective rate (OR = 3.84, 95% CI: 2.79-5.27, p < 0.00001), MMSE scores (MD = 2.86, 95% CI: 2.02-3.71, p < 0.00001), MoCA scores (MD = 2.21, 95% CI: 1.63-2.80, p < 0.00001), and ADL (SMD = 1.62, 95% CI: 1.02-2.22, p < 0.00001), despite substantial heterogeneity. Subgroup analyses suggested enhanced benefits when SBP was part of combination therapy or for treatment durations under three months. No serious adverse events were reported. CONCLUSION: SBP acupuncture may have potential benefits for cognitive function in patients with PSCI, particularly when combined with other therapies or used for shorter durations. However, these cognitive findings should be considered preliminary due to methodological limitations and high heterogeneity. The benefits for ADL outcomes remain uncertain due to very low certainty of evidence and potential publication bias. The safety profile appeared acceptable based on available data. Further large-scale, multicenter, registered RCTs with rigorous methodologies and long-term follow-up are warranted. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251142773, identifier CRD420251142773.