To compare the efficacy of various non-invasive brain stimulation techniques (NIBS) in enhancing cognition following stroke.

Post-stroke-cognitive-impairment (PSCI) affects around 80% of patients, and is currently treated with drugs and cognitive rehabilitation. NIBS, including transcranial-magnetic-stimulation (TMS) and transcranial-direct-current-stimulation (tDCS), has emerged as a potential therapy, but its efficacy remains uncertain.

We systematically searched Pubmed, ScienceDirect, Clinical trial, Embase, Web of Science, Scopus, and Cochran until July of 2025 for NIBS efficacy studies on adults with confirmed PSCI. The primary outcomes were cognitive improvement measured by the Montreal-Cognitive-Assessment (MoCA) or Mini-Mental-State-Examination (MMSE), and functional outcomes assessed by the Modified-Barthel-Index (MBI) or Functional-Independence-Measure (FIM). Risk of bias was assessed using RoB2. Meta-analyses were conducted using R v4.4.2, and network meta-analysis using MetaInsight v6.4.0 under a Bayesian framework.

Sixteen studies with 1397 patients were included. Meta analysis showed that NIBS significantly improved MoCA (SMD = 0.54, 95%CI 0.28-0.80), MMSE (SMD = 0.62, 95%CI 0.46-0.79), as well as MBI and FIM (SMD = 0.65, 95% CI 0.23-1.07). In subgroup analysis, TMS significantly improved MoCA (SMD = 0.71, 95%CI 0.45-0.98), MMSE (SMD = 0.70, 95%CI 0.53-0.87), and MBI and FIM (SMD = 0.59, 95%CI 0.22-0.96). However, tDCS did not show any significant improvement across all measures. In the network meta-analysis, the surface under the cumulative ranking curve (SUCRA) values showed that for MoCA and MMSE, TMS ranked higher than tDCS (97.64% versus 27.23%, and 95.9% versus 35.63%, respectively). However, for MBI/FIM, tDCS ranked higher than TMS (85% versus 63.12%).

NIBS improves cognitive and functional outcomes after stroke. TMS demonstrates a higher efficacy across cognitive measures, while tDCS might be better for functional outcomes.