# Acceptance and Commitment Therapy modulates immuneinflammatory responses and neurotrophic factors homeostasis in elderly stroke patients: A randomized controlled trial

## TL;DR

This study shows that Acceptance and Commitment Therapy (ACT) helps elderly stroke patients by improving immune balance, reducing inflammation, and boosting brain repair factors.

## Contribution

The study demonstrates that ACT has multi-target effects on immune, inflammatory, and neurotrophic pathways in elderly stroke patients.

## Key findings

- ACT reduced proinflammatory cytokines and increased anti-inflammatory IL-10 in stroke patients.
- ACT improved T-cell subset balance and elevated neurotrophic factors like BDNF and IGF-1.
- ACT mitigated oxidative stress by reducing lipid peroxidation markers and enhancing antioxidant enzymes.

## Abstract

This study examined the regulatory effects of Acceptance and Commitment Therapy (ACT) on T lymphocyte subsets, serum inflammatory cytokines, neurotrophic factors, antioxidant enzymes, and lipid peroxidation products in elderly cerebral stroke (CS) patients, providing insights into the multi-dimensional pathophysiological interactions and potential intervention strategies for chronic stroke recovery.

In this randomized controlled trial, 120 elderly stroke patients were allocated to either an ACT group (ACT intervention; n = 60) or a routine group (conventional treatment; n = 60). Comprehensive assessments were performed to quantify: (1) peripheral T lymphocyte distribution (CD3+, CD4+, CD8+ subsets, and CD4+/CD8+ ratio), (2) serum inflammatory cytokines (IL-1p, IL-6, IL-10, and TNF-a), (3) neurotrophic factors (5-HT, NE, BDNF, and IGF-1), and (4) antioxidant enzymes (SOD, CAT) and lipid peroxidation products (MDA, NO) using flow cytometry, HPLC-ECD, and ELISA. Statistical analyses were conducted with SPSS 22.0.

Following treatment, CS patients exhibited reduced CD3+ and CD4+ T-cell levels along with a decreased CD4+/CD8+ ratio, while CD8+ T-cell proportions were elevated (P< 0.05). Proinflammatory cytokine levels (IL-1 b, IL-6, and TNF-a) were significantly suppressed, whereas anti-inflammatory IL-10 expression increased (P < 0 .0 5 ). Notably, ACT demonstrated superior efficacy in restoring immune balance and attenuating inflammation compared to conventional intervention (P< 0.05). Furthermore, neurotrophic factors levels were elevated, and oxidative stress markers were ameliorated in CS after treatment (P< 0.05), suggesting that ACT enhances neurotrophic activity and mitigates oxidative injury.

ACT likely confers neuroprotection through multi-target mechanisms, including modulation of T-cell subset homeostasis, upregulation of neurotrophic factors, and suppression of oxidative stress.