Acupuncture for vascular mild cognitive impairment: an updated systematic review and meta-analysis of randomized controlled trials.

BACKGROUND

Vascular mild cognitive impairment (VMCI) is a potentially transitional state between normal aging and vascular dementia. The presence of macroscopic white matter lesions (WML) of moderate or severe extension on brain MRI is the hallmark of the vascular mild cognitive impairment.

OBJECTIVE

To assess the effectiveness and safety of acupuncture for vascular mild cognitive impairment.

METHODS

Six electronic databases and two clinical trial websites were searched for randomized controlled trials which investigated the effects of acupuncture compared with sham acupuncture, drugs or usual care (such as cognitive rehabilitation). Studies comparing acupuncture combined with other therapies with this therapy alone for VMCI were also included. The quality of the trials selected was evaluated according to the Cochrane 'risk of bias' tool. RevMan V.5.4 software was employed for data analysis. Risk ratio (RR) or mean difference (MD) and their 95% confidence interval (CI) were used for a dichotomous or continuous variable, respectively.

RESULTS

Forty-nine trials with 3555 participants were included, with the exception of one trial judged to have a low risk of bias, 43 trials were all judged to have some concerns or a high risk of bias. Meta-analysis showed superior effect of acupuncture as add-on treatment to usual care on increasing the MMSE scores (MD 2.15, 95% CI 1.61 to 2.69, 7 trials, 536 participants, I2 = 22%, P < 0.00001). Five trials also found superior effect of body acupuncture as add-on treatment to usual care on increasing the MoCA scores (MD 2.50, 95% CI 1.80 to 3.20, 5 trials, 340 participants, I2 = 0%, P < 0.00001). Among the included studies, two studies reported adverse reactions.

CONCLUSIONS

Acupuncture seems to be a promising treatment for vascular cognitive impairment to slow the progression of the disease and improve cognitive function. However, evidence is limited due to heterogeneity and the small number of included trials.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022382245.