Acorus tatarinowii volatile oil inhalation combined with Fengchi (GB20) acupuncture enhances cognitive recovery in post-stroke patients

OBJECTIVE: To evaluate the efficacy of Acorus tatarinowii volatile oil inhalation combined with Fengchi (GB20) acupuncture on cognitive function in post-stroke cognitive impairment (PSCI) patients and clarify its role in cognitive improvement. METHODS: This single-center retrospective cohort study included 235 PSCI patients (January 2023-December 2024), divided into acupuncture group (routine rehabilitation + Fengchi electroacupuncture, n = 125) and combination group (additionally Acorus tatarinowii volatile oil inhalation, n = 110). After 1:1 propensity score matching, 92 patients per group were analyzed. The primary outcomes were changes in the Mini-Mental State Examination (ΔMMSE) and Montreal Cognitive Assessment (ΔMoCA) scores before and after treatment. Secondary outcomes included changes in the Modified Barthel Index (ΔMBI) and mean flow velocity (ΔMFV) in cerebral arteries measured by transcranial Doppler (TCD). Multivariate linear/logistic regression and model validation were performed. RESULTS: Baseline characteristics were balanced after matching. At 3 months both groups improved on MMSE, MoCA, and MBI (all P < 0.001), with greater gains in the combination group (P < 0.01). Combination therapy produced larger increases in MFV across major cerebral arteries (all P < 0.05). Combined therapy was an independent positive predictor of cognitive improvement (multivariate linear regression: ΔMMSE β = 1.84, P < 0.001; ΔMoCA β = 1.27, P = 0.006; logistic regression: odds ratio [OR] = 2.19, 95% confidence interval [CI]: 1.05-4.56, P = 0.036). The predictive model demonstrated good discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.83. CONCLUSION: Acorus tatarinowii volatile oil inhalation combined with Fengchi acupuncture is superior to acupuncture alone in promoting cognitive recovery and functional independence in patients with post-stroke cognitive impairment. The benefits are associated with improved cerebral hemodynamics and warrant further validation in prospective randomized controlled trials (RCTs).