BackgroundStroke is recognized as the second primary cause of mortality and disability worldwide. Cognitive dysfunction often remains a residual issue post-stroke.ObjectiveTo explore the impact of integrating scalp acupuncture with iTBS therapy on cognitive impairments post-stroke.MethodsThis study was a randomized, controlled, single-blind trial. Fifty-four patients completed the study and were allocated into the SA group, iTBS group, and combined group using a random number table method. The SA group received scalp acupuncture treatment for 4 weeks, the iTBS group underwent intermittent theta burst stimulation for 4 weeks, and the combined group received both scalp acupuncture and iTBS treatments for 4 weeks. All enrolled patients also received standard pharmacological and conventional rehabilitation treatments, six days a week, for four weeks in total. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) before treatment (baseline) and after treatment (4 weeks). Additionally, changes in cerebral hemodynamics during the experiment were measured using functional near-infrared spectroscopy (fNIRS).ResultsScalp acupuncture therapy, iTBS therapy, and the combination of scalp acupuncture with iTBS therapy all significantly activated the cortical regions of the frontal and temporal lobes in patients with Post-Stroke Cognitive Impairment No Dementia (PSCIND) (< 0.05). Compared to scalp acupuncture or iTBS therapy alone, the combined therapy activated more channels, with more significant activation in the right Superior Temporal Cortex (r-STC), right Ventrolateral Prefrontal Cortex (r-VLPFC), Medial Prefrontal Cortex (mPFC), left Ventrolateral Prefrontal Cortex (l-VLPFC), right Superior Frontal Cortex (r-SFC), and left Dorsolateral Prefrontal Cortex (l-DLPFC) (< 0.05). The combined therapy enhances cognitive functions in PSCIND patients, exhibiting superior clinical effectiveness compared to either scalp acupuncture or iTBS therapy when used individually (< 0.05).ConclusionThe combination of scalp acupuncture with iTBS therapy represents a novel and promising neurorehabilitation treatment technique for post-stroke cognitive impairment. Future clinical research is needed to explore its therapeutic mechanisms and further refine this technique.