REVIEW article
Front. Neurol.
Sec. Neurorehabilitation
Integrative Neurobiological Mechanisms of Acupuncture in Post-Stroke Cognitive Impairment: From Neurotransmission to Brain Network Remodeling
Wei Li
Lebin Liu
Weiwei Liu
Huiping Liu
Hubei Provincial Hospital for Veterans and Special Care, Wuhan, China
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Abstract
Post-stroke cognitive impairment (PSCI) is a prevalent sequela of stroke that se verely limits recovery and quality of life. Accumulating evidence indicates that acupuncture exerts significant neuroprotective and cognitive-enhancing effects i n PSCI; however, the underlying mechanisms remain fragmented across molecu lar, cellular, and systems levels. This review proposes an integrative neurobiolo gical framework linking neurotransmission, neuroinflammation, neurotrophic sign aling, and brain network remodeling to explain how acupuncture promotes neur orepair and cognitive restoration after stroke. We systematically summarized rec ent clinical and experimental findings from 2001 to 2025 and categorized the c onverging mechanisms into five inter-related dimensions: (1) regulation of neur otransmitters and synaptic plasticity; (2) anti-inflammatory and immune modulat ion; (3) anti-oxidative stress and anti-apoptotic actions; (4) up-regulation of BD NF-related pathways and neurotrophic signaling; and (5) enhancement of neurog enesis and reconstruction of brain functional networks. Collectively, these multi modal effects form a systems-level cascade through which acupuncture may fac ilitate neuroplastic remodeling and cognitive recovery. Current challenges includ e heterogeneity of study design, insufficient multi-omics validation, and limited longitudinal imaging evidence. Future research should integrate molecular biom arkers, neuroimaging, and clinical outcomes to verify this multi-layered mechani stic framework and to guide precision acupuncture protocols for PSCI rehabilita tion.
Summary
Keywords
Acupuncture, BDNF signaling, Brain network remodeling, Neuroinflammation, neuroplasticity, neurotransmission, post-stroke cognitive impairment, Systems neurobiology
Received
11 November 2025
Accepted
05 February 2026
Copyright
© 2026 Li, Liu, Liu and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Wei Li
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.