Multi-target synergism and integration: Mechanism of acupuncture for post-stroke cognitive impairment

Abstract

Post-stroke cognitive impairment (PSCI) is a common disabling complication after stroke. Acupuncture can effectively improve learning and memory function in patients with PSCI and enhance their quality of life in long term. Research on its effect mechanisms has evolved from phenomenological observation to multidimensional exploration progressively. In this paper, recent studies on effect mechanisms of acupuncture for PSCI were collected, which revealed that acupuncture can alleviate PSCI through multi-target synergism. The therapeutic mechanism of acupuncture primarily involves reducing immune damage in the brain by suppressing neuroinflammation, and promoting synaptic and memory circuit reconstruction through enhancing neural plasticity, egulating autophagy and maintaining the stability of neurovascular units as the critical auxiliary pathways, which can synergistically remove the damage products and preserve the neuronal microenvironment. Furthermore, emerging research directions such as modulating gut microbiota, influencing epigenetics, and improving brain metabolism expand the mechanistic understanding. However, existing studies predominantly isolate and describe individual mechanisms without integrating their intrinsic correlations, nor do they adequately elucidate the corresponding relationships between different acupuncture techniques and their therapeutic advantages. Therefore, this review integrates the fragmented mechanistic evidences, and emphasizes that future research need multi-omics approaches, so as to explore the synergistic relationships among mechanisms, and to strengthen the correlative research between the specificity of acupuncture regimens and clinical effect, in order to facilitate bench-to-bedside translation.