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

Abstract

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.