Liao Yuan-Ling, Hsu Pei-Shan, Lee Chang-Ti, Su Li-Jen, Shen Yi-Ying, Tsou Adam, Lan Chou-Chin, Tzeng I-Shiang, Liu Guan-Ting, Hsieh Po-Chun
Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
Department of Biomedical Sciences and Engineering, National Central University, Jhongli, Taiwan.
Front Aging Neurosci. 2025 Jun 16;17:1559388. doi: 10.3389/fnagi.2025.1559388. eCollection 2025.
Vascular cognitive impairment (VCI) is the second most frequent form of cognitive disorder. It is mainly caused by a diseased cerebral vasculature and affects patients' cognition and activities of daily living (ADL). Previous studies have demonstrated that acupuncture therapy is a promising complementary treatment that significantly improves cognitive status and ADL in VCI patients. This study aimed to investigate the effects of different types of acupuncture therapies and conventional treatments on cognitive status and ADL in VCI patients to provide evidence-based clinical recommendations.
We searched seven electronic databases for randomized controlled trials comparing acupuncture therapies [including manual acupuncture (MA), scalp acupuncture (SA), electroacupuncture (EA), and auricular acupuncture (AA)] with conventional treatment [pharmacotherapy (P), cognitive rehabilitation (CR)] or standard care (SC) in patients with VCI. The primary outcome was cognitive improvement, while secondary outcomes included improvement in ADL and the risk of severe adverse effects. A frequentist random-effects network meta-analysis was performed under a consistency model. Study quality was assessed using the RoB 2.0 tool. Inconsistency was examined via node-splitting. Subgroup analysis, meta-regression, and sensitivity analysis were conducted to explore heterogeneity and assess robustness. Publication bias was evaluated using funnel plots and Egger's test.
Through stepwise exclusion of studies contributing to publication bias and inconsistency, a robust bias-adjusted network meta-analysis dataset was established. The results showed that among all interventions, SA+P+SC demonstrated the greatest efficacy in improving cognitive status compared to SC (SMD: 2.04; 95% CI: 1.21-2.86) with substantial heterogeneity (I = 71.0%), no significant inconsistency, and relative low publication bias ( = 0.7020).
Acupuncture, particularly SA combined with P and SC, appears to be a safe and effective adjunctive treatment for patients with VCI. Future studies are warranted to establish VCI-specific MCID thresholds and to validate these findings through large-scale, high-quality RCTs.
https://inplasy.com/inplasy-2023-5-0114/, identifier INPLASY202350114.
血管性认知障碍（VCI）是第二常见的认知障碍形式。它主要由脑血管病变引起，影响患者的认知和日常生活活动（ADL）。先前的研究表明，针灸疗法是一种有前景的辅助治疗方法，可显著改善VCI患者的认知状态和ADL。本研究旨在探讨不同类型的针灸疗法和传统治疗对VCI患者认知状态和ADL的影响，以提供循证临床建议。
我们检索了七个电子数据库，以查找比较针灸疗法[包括手针（MA）、头皮针（SA）、电针（EA）和耳针（AA）]与传统治疗[药物治疗（P）、认知康复（CR）]或标准护理（SC）在VCI患者中的随机对照试验。主要结局是认知改善，次要结局包括ADL改善和严重不良反应风险。在一致性模型下进行频率学派随机效应网络荟萃分析。使用RoB 2.0工具评估研究质量。通过节点拆分检查不一致性。进行亚组分析、荟萃回归和敏感性分析以探索异质性并评估稳健性。使用漏斗图和Egger检验评估发表偏倚。
通过逐步排除导致发表偏倚和不一致性的研究，建立了一个稳健的经偏倚调整的网络荟萃分析数据集。结果显示，在所有干预措施中，与SC相比，SA+P+SC在改善认知状态方面显示出最大疗效（标准化均数差：2.04；95%可信区间：1.21 - 2.86），存在较大异质性（I² = 71.0%），无显著不一致性，且发表偏倚相对较低（P = 0.7020）。
针灸，特别是SA联合P和SC，似乎是VCI患者安全有效的辅助治疗方法。未来的研究有必要建立VCI特异性的最小临床重要差异阈值，并通过大规模、高质量的随机对照试验验证这些发现。
https://inplasy.com/inplasy-2023-5-0114/，标识符INPLASY202350114。
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