Deans' stroke musings: Comparative efficacy of 5 non-pharmacological therapies for adults with post-stroke cognitive impairment: A Bayesian network analysis based on 55 randomized controlled trials

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, October 13, 2022

Comparative efficacy of 5 non-pharmacological therapies for adults with post-stroke cognitive impairment: A Bayesian network analysis based on 55 randomized controlled trials

So further research required. Will never occur, there is NO STROKE LEADERSHIP to contact to get it done.

Comparative efficacy of 5 non-pharmacological therapies for adults with post-stroke cognitive impairment: A Bayesian network analysis based on 55 randomized controlled trials

Zhendong Li¹,

Lei Yang¹,

Hangjian Qiu²,

Xiaoqian Wang²,

Chengcheng Zhang¹ and

Yuejuan Zhang¹^*

¹Department of Nursing, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
²School of Nursing, Hunan University of Chinese Medicine, Changsha, China

Background: As a common sequela after stroke, cognitive impairment negatively impacts patients' activities of daily living and overall rehabilitation. Non-pharmacological therapies have recently drawn widespread attention for their potential in improving cognitive function. However, the optimal choice of non-pharmacological therapies for post-stroke cognitive impairment (PSCI) is still unclear. Hence, in this study, we compared and ranked 5 non-pharmacological therapies for PSCI with a Bayesian Network Meta-analysis (NMA), to offer a foundation for clinical treatment decision-making.

Methods: PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Chinese Biomedical Medicine, China National Knowledge Infrastructure, Wangfang Database, and China Science and Technology Journal Database were searched from database inception to December 31, 2021, to collect Randomized Controlled Trials for PSCI. All of the studies were assessed (according to Cochrane Handbook for Systematic Reviews) and then data were extracted by two researchers separately. Pairwise meta-analysis for direct comparisons was performed using Revman. NMA of Bayesian hierarchical model was performed by WinBUGS and ADDIS. STATA was used to construct network evidence plots and funnel plots.

Results: A total of 55 trials (53 Two-arm trials and 2 Three-arm trials) with 3,092 individuals were included in this study. In the pair-wise meta-analysis, Transcranial Magnetic Stimulation (TMS), Virtual Reality Exposure Therapy (VR), Computer-assisted cognitive rehabilitation (CA), Transcranial Direct Current Stimulation (tDCS), and Acupuncture were superior to normal cognition training in terms of MoCA, MMSE, and BI outcomes. Bayesian NMA showed that the MoCA outcome ranked Acupuncture (84.7%) as the best therapy and TMS (79.7%) as the second. The MMSE outcome ranked TMS (76.1%) as the best therapy and Acupuncture as the second (72.1%). For BI outcome, TMS (89.1%) ranked the best.

Conclusions: TMS and Acupuncture had a better effect on improving cognitive function in post-stroke patients according to our Bayesian NMA. However, this conclusion still needs to be confirmed with large sample size and high-quality randomized controlled trials.

Registration: https://inplasy.com (No. INPLASY202260036).

Introduction

Post-stroke cognitive impairment (PSCI) is a common comorbidity of stroke, and the prevalence of it varies enormously across studies (17.6–83%), depending on the time of assessment, the study environment, the demographic variables, and the numerous cognitive tests and cut-offs that were utilized (1). PSCI is defined as a clinical syndrome characterized by any sort of cognitive neurodegeneration after stroke, ranging from mild impairment to a more severe form: post-stroke dementia (2, 3). Disruptions in advanced brain functions such as attention, language, memory, executive, and visuospatial function are the most common symptoms of PSCI, which not only have a negative impact on patients' activities of daily living and overall rehabilitation (4–6) but also linked closely to a higher risk of recurrent ischemic stroke (7) and a lower 5-year survival rate (2). In addition, the ongoing care and support needs required by PSCI patients are closely related to the increased physical and psychological burden of family caregivers (8) and the medical and economic burden on society (9). To sum up, PSCI has become a major public health concern that has to be addressed promptly as the great burden of stroke continues to climb (10, 11).

Currently, pharmaceutical interventions such as Acetylcholinesterase inhibitors, memantine, galantamine, etc., which are mainly approved for use in Alzheimer's disease have shown some clinical benefits in vascular dementia (12, 13). Unfortunately, a recent study revealed that little evidence demonstrates they helped symptoms or slowed dementia progression down in PSCI patients (14). On the contrary, side effects and adverse reactions such as gastrointestinal issues (diarrhea or constipation), headaches, dizziness, and so on, do exist in pharmaceutical interventions (15). Therefore, non-pharmacological therapies such as Transcranial Magnetic Stimulation (TMS) (16), Transcranial Direct Current Stimulation (tDCS) (17), Computer-assisted cognitive rehabilitation (CA) (18), Virtual Reality Exposure Therapy (VR) (19), and Acupuncture (20), which have been found have a positive impact on cognitive function of PSCI patients in several systematic review and meta-analysis, have gradually aroused people's attention (21).

However, due to a lack of manpower and resources, most studies to date have only compared individual therapy to traditional cognition training or, at most, two therapies. Direct comparisons provide little useful information for determining which therapy is more appropriate for PSCI patients. It is obvious that a deeper exploration to assess the relative value between different interventions will be greatly helpful for medical decisions and the rehabilitation of PSCI patients. Network meta-analysis is an extension of pairwise meta-analysis that allows data from multiple clinical trials evaluating at least two treatments to be pooled. The incorporation of both direct and indirect information strengthens inferences about each treatment's relative efficacy (22, 23).

Therefore, in the present study, we included 55 RCTs and used Bayesian Network Meta-analysis (NMA) to assess and rank the efficacy of the 5 different alternative strategies listed above, in order to find the best treatment plan for PSCI patients and to provide an evidence-based foundation for clinical treatments decision-making.