Internal Medicine B Department, 37772Bnai Zion Medical Center, Haifa, Israel.
Complementary Medicine Department, 37772Bnai Zion Medical Center, Haifa, Israel.
J Geriatr Psychiatry Neurol. 2022 May;35(3):333-343. doi: 10.1177/0891988721996804. Epub 2021 Mar 9.
Acupuncture seems to improve cognitive function in experimental models and to reduce agitation in dementia. The addition of acupuncture to standard-of-care (SOC) may improve clinical outcomes related to delirium in hospitalized older adults.
This pragmatic open-label randomized-controlled trial evaluated 81 older adults hospitalized in an internal medicine ward and diagnosed with delirium. Fifty were randomized to daily acupuncture combined with SOC and 31 to SOC only for up to 1 week. Delirium was diagnosed using Confusion Assessment Method (CAM) tool, and its severity was assessed by the long CAM-Severity (CAM-S) tool. The primary study outcome was delirium resolution evaluated as time-to-first delirium remission (over 7 days) and the number of days spent delirium-free.
Time-to-first delirium remission was shorter in the acupuncture arm as compared to the SOC only arm (p < 0.001). A multivariate Cox regression analysis showed a shorter time-to-first remission of delirium in the acupuncture arm as compared with SOC arm [Hazard Ratio 0.267 (95% CI 0.098-0.726, p = 0.010)]. In the 7 days of evaluation, a significantly higher number of delirium-free days was found in the acupuncture arm compared to the SOC arm (p < 0.001), and CAM-S sum from day 2 to day 7 of evaluation was significantly lower in the acupuncture group compared to the control group (p = 0.002). No adverse safety event was found in the acupuncture group.
Acupuncture seems to be safe and effective in the treatment of delirium in older patients hospitalized in internal medicine departments.
针灸似乎可以改善实验模型中的认知功能，并减少痴呆症患者的激越。在标准治疗（SOC）的基础上增加针灸可能会改善与住院老年患者谵妄相关的临床结局。
这项实用的开放性标签随机对照试验评估了 81 名在老年内科病房住院并被诊断为谵妄的老年人。50 名被随机分配到每日针灸联合 SOC 组，31 名仅接受 SOC 治疗，最多 1 周。使用意识模糊评估法（CAM）工具诊断谵妄，并用长版 CAM 严重程度（CAM-S）工具评估其严重程度。主要研究结局是根据 7 天内谵妄缓解情况评估的首次谵妄缓解时间（超过 7 天）和无谵妄天数。
与 SOC 组相比，针灸组的首次谵妄缓解时间更短（p < 0.001）。多变量 Cox 回归分析显示，与 SOC 组相比，针灸组的首次谵妄缓解时间更短[风险比 0.267（95%置信区间 0.098-0.726，p = 0.010)]。在 7 天的评估中，针灸组无谵妄天数明显多于 SOC 组（p < 0.001），且评估第 2 天至第 7 天的 CAM-S 总分在针灸组中显著低于对照组（p = 0.002）。针灸组未发现不良安全事件。
针灸似乎对内科住院老年患者的谵妄安全有效。
