Author(s)

Jialai Zhu ¹

Affiliation(s)

¹ The Second People's Hospital of Pingyang County, Department of Neurosurgery, Wenzhou, Zhejiang, China

Corresponding Author

Jialai Zhu

ABSTRACT

This study aimed to compare the differential effects of two pharmacological regimens—the cholinesterase inhibitor donepezil and the cerebrovasodilator nicergoline—on neuroimaging biomarkers in patients with post-stroke cognitive impairment (PSCI) and to explore their relationship with cognitive improvement. A prospective, randomized, open-label, parallel-group controlled design was adopted. Ninety-six eligible PSCI patients were randomly assigned to the donepezil group (Group A, n=48) or the nicergoline group (Group B, n=48). Both groups received 24 weeks of target drug therapy on top of routine treatment. All patients underwent multimodal magnetic resonance imaging (MRI) before and after treatment, including 3D-T1-weighted imaging, diffusion tensor imaging, resting-state functional MRI, and 3D arterial spin labeling sequences, to assess brain structure, white-matter integrity, functional connectivity, and cerebral blood flow. Cognitive function was evaluated using the Montreal Cognitive Assessment and the Digit Symbol Substitution Test. The primary endpoint was between-group differences in neuroimaging metrics. Ninety-three patients completed the study. In terms of brain structure, the donepezil group showed significantly greater increases in bilateral hippocampal volume (e.g., left side from 2.85 to 3.02 cm³) compared with the nicergoline group (P<0.05). Regarding brain function, the donepezil group exhibited a more pronounced enhancement of default-mode network functional connectivity (P<0.05). However, in improving cerebral perfusion, the nicergoline group achieved a significantly larger elevation in whole-brain mean cerebral blood flow (from 46.1 to 52.3 ml/100g/min) than the donepezil group (P<0.01). Cognitive assessments revealed that the donepezil group had an advantage in global cognitive improvement, and its improvement in MoCA score was positively correlated with increased hippocampal volume (r=0.432); in the nicergoline group, improvement in processing speed was associated with increased cerebral blood flow (r=0.398). Safety profiles were similar between the two groups Donepezil and nicergoline demonstrate distinct targeting patterns in improving brain health in PSCI patients: donepezil preferentially promotes structural plasticity and functional integration of the memory-related limbic system, whereas nicergoline shows superior efficacy in enhancing whole-brain hemodynamic perfusion. These findings suggest that selecting individualized drug regimens based on multimodal neuroimaging characteristics holds potential clinical value.

KEYWORDS

Post-stroke cognitive impairment; Donepezil; Nicergoline; Magnetic resonance imaging; Hippocampus; Cerebral blood flow

CITE THIS PAPER

Jialai Zhu, Differences in the Improvement of Neuroimaging Biomarkers between Two Pharmacological Regimens in Patients with Post-Stroke Cognitive Impairment. MEDS Clinical Medicine (2025) Vol. 6: 154-161. DOI: http://dx.doi.org/10.23977/medsc.2025.060522.

REFERENCES

[1] Li Hongyang, Wu Tingting, Zhang Zhiliang, et al. Efficacy of Citicoline Sodium Combined with Donepezil in the Treatment of Post-Stroke Cognitive Dysfunction in the Elderly[J]. Chinese Journal of Gerontology, 2025, 45(07):1640-1643.
[2] Yang Jingyi, Wang Yunqin. Observation on the Efficacy of Wulong Huanshao Decoction Combined with Donepezil Tablets in the Treatment of Post-Ischemic Stroke Cognitive Impairment No Dementia with Spleen-Kidney Deficiency Syndrome[J]. Basic Traditional Chinese Medicine, 2025, 4(03):52-57.
[3] Wu Xing, Bi Tingting, Han Xuefei, et al. Clinical Study of Butylphthalide Combined with Donepezil Hydrochloride and Atorvastatin Calcium in the Treatment of Cognitive Dysfunction after Cerebral Infarction[J]. Evaluation and Analysis of Drug-Use in Hospitals of China, 2025, 25(01):53-56+60.
[4] She Xiaomei, Zhang Liangliang, Zhang Li. Efficacy of Nicergoline Combined with Transcranial Stimulation Instrument in the Treatment of Patients with Post-Stroke Cognitive Impairment and Its Effect on Cerebral Metabolism[J]. Chinese Journal of Practical Nervous Diseases, 2024, 27(08):966-970.
[5] Wu Xiaoping, Ma Long, Wu Wei, et al. Clinical Effect of Maiguan Fukang Capsule Combined with Nicergoline in the Treatment of Post-Cerebral Infarction Cognitive Impairment with Syndrome of Internal Obstruction of Static Blood[J]. China Medical Herald, 2023, 20(17):86-89.

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