| Objective Alzheimer's disease,also known as senile dementia,is a chronic neurodegenerative disease.The disease is characterized by occult onset and progressive development,but the decline is slow.Seriously affect the physical and mental health of patients and quality of life,Alzheimer's disease often occurs in the elderly,often to their families bring heavy psychological burden and economic pressure.Drug treatment does not extend the life span or prolong the course of the disease.Western medicine has not yet developed a special treatment for senile dementia,mostly for symptomatic treatment.In recent years,Chinese medicine has conducted in-depth research on the etiology,pathogenesis,and treatment of Alzheimer's disease,and has made remarkable progress.At present,more and more scholars at domestic and foreign are conducting clinical research on acupuncture and moxibustion in treating senile dementia.The number of clinical studies on acupuncture and moxibustion for senile dementia is increasing,and there are more and more literatures on clinical randomized controlled trials.There are few literatures about evaluating the effectiveness and safety of acupuncture treatment for Alzheimer's disease,so it is particularly important that how to analyze and evaluate this kind of literature from an objective perspective and objectively assess the effectiveness and safety of acupuncture in the treatment of Alzheimer's disease.Evidence-based medicine can be combined with related research to increase the sample size of research and more accurately evaluate the research results of related research.Therefore,more and more scholars pay attention and research.This study intends to analyze and evaluate the clinical efficacy and safety of acupuncture for the treatment of Alzheimer's disease through the use of evidence-based medicine,using literature review and meta-analysis,to arrive at acupuncture for the treatment of Alzheimer's disease.The effectiveness and safety of the acupuncture treatment of senile dementia clinical evidence to provide evidence-based medicine,so as to better serve clinical treatmentMethod(1)Search method: According to a unified search strategy,a randomized controlled clinical trial of acupuncture for senile dementia was conducted through a computerized literature database.The search databases are CNKI,CBM,Wan Fang,VIP,Pubmed,Embase and Web of science.The search term is a combination of free word and subject word.The search terms are: \dementia\,\senile dementia\,\Alzheimer's disease\,\cognitive disorder\,\acupuncture\,\acupuncture\,\needle Law \,\ moxibustion.Document retrieval time: January 2008-January 2018.We included all clinical randomized controlled trials published in Chinese and using acupuncture or acupuncture combined with Chinese herbal decoction as main intervention measures.After searching relevant documents that meet the established requirements,the researcher must also retrospect the references cited in the related documents and include as many comprehensive relevant researches as possible,minimize the possibility of missed inspections,and import relevant documents retrieved.Noteexpress literature management software,using software to check the weight,and then view the title,abstract of the literature,if necessary,view the full text,to exclude the documents do not meet the inclusion criteria,the final screen out of qualified documents that meet the system evaluation.(2)Inclusion criteria:(1)The published time of the publication was from January 2008 to January 2018;(2)The study participants were patients with senile dementia in China;(3)The interventions adopted in the study were acupuncture or acupuncture Chinese herbal decoction;(4)The experimental protocol was: A randomized controlled design protocol;(5)Efficacy evaluation indicators should be clear and should include the MMSE score,the ADL score,the ADAS-Cog score,clinical dementia Assessment form(CDR)scores,changes in the revised MBI score,Chinese Sexual Dementia Syndrome Rating Scale(SDSD) score,Blessed behavioral scale score,Hasegawa Dementia Scale(HDS)score,Montreal cognitive assessment One or more of the evaluation indicators such as the table(Mo CA)scores.(3)Exclusion criteria:(1)it is not a literature of clinical randomized controlled trials;(2)literature does not provide systematic statistics and analysis of the results;(3)repeated reports;(4)other types of dementia such as vascular dementia;Accurate or no end-point judgment index;(5)The number of related clinical studies reported in the literature,which cannot be effectively extracted from the research data,should be deleted;(6)The research subjects are animals,mainly reported by adverse clinical reports,and mainly drug research.Pharmacology,pharmacokinetics and other non-clinical evaluation studies related literature;(7)statistical analysis methods are not clear clinical trials;(8)literature review,clinical case reports,relevant clinical experts personal experience report;(9)simple description of the study.(4)Literature evaluation methods: All the documents included in the systematic review were independently reviewed by two related professional researchers.The researchers first had to look at the title of the document,then review the abstract,and read the full text of the included documents if necessary.For the documents that meet the established inclusion criteria,each researcher must also evaluate the quality of the final eligible documents and extract the required literature information.Cross-checks are also conducted.If there are inconsistencies,the two people discuss and analyze together.The opinions are consistent,if the opinions are not uniform,the third researcher should be invited to solve the problem.(5)Statistical methods: Statistical methods were processed using the Rev Man5.3 statistical software provided by Cochrane Collaboration for meta-analysis.The odds ratio(OR)was used as the efficacy analysis statistic for the count data.Mean difference(MD)was used for the measurement data,and standardized mean difference(SMD)was used for different measurement units.All are represented by 95% CI.The x2 test was used for the heterogeneity among the results of each of the included studies.If there was a statistical heterogeneity(P50%),the source of heterogeneity was analyzed.If there is a very significant clinical heterogeneity between different clinical studies,we will only descriptively analyze them in the study.When necessary,we perform a sensitivity analysis test.Result(1)The results of the literature search initially detected 2,643 articles,of which 490 were retrieved by CNKI,524 were retrieved by Chinese Biomedical Literature Database(CBM),and 525 were retrieved by Wan Fang(Chinese).806 records were retrieved from the database(VIP).122 were retrieved by Pubmed?20 were retrieved by Embase?156 were retrieved by Web of science Through exclusion of duplicates,45 eligible randomized controlled trials were screened out according to the inclusion and exclusion criteria.(2)Acupuncture treatment compared with conventional treatment,acupuncture treatment in the improvement of Alzheimer's disease patients with Mini-Mental State Examination(MMSE)score(MD 2.16,[1.74,2.86] P<0.01I2=81%),the overall treatment efficiency(OR 3.58,[2.73,4.69] P=0.86I2=0%),,the clinical dementia rating scale(CDR)score(MD-0.55,[-0.96,-0.14] P=0.04 I2=76%)and modified Barthel Index(MBI)score changes(MD 10.71,[1.43,19.98] P=0.06 I2=72%),dementia TCM syndrome score scale(SDSD)score(MD-2.47,[-3.47,-1.47] P=0.94 I2=0%),Kyohko Hasegawa Dementia Scale(HDS)score(MD 4.47,[2.50,6.44] P=0.44 I2=0%),The Montreal Cognitive Assessment(Mo CA)score(MD 3.95,[0.81,7.08] P=0.02 I2=80%)had a significant effect.(3)Acupuncture treatment compared with conventional treatment,acupuncture treatment in the improvement of Alzheimer's disease patients with Activity Daily Living Scale(ADL)score(MD-0.98,[-2.50,0.55] P<0.01I2=93%),Alzheimer's Disease Rating Scale-Cognitive score(ADAS-Cog)(MD-2.50,[-5.13,0.14] P=0.06 I2=69%),Blessed Behavior Scale score(MD 1.78,[-0.69,4.25] P=0.001 I2=91%)were not significantly improved.(4)The combination of acupuncture plus Chinese herbal decoction combined with conventional treatment,acupuncture plus Chinese herbal decoction combined therapy to improve patients with Mini-Mental State Examination(MMSE)score(MD 1.62,[0.61,2.64] P<0.01 I2=77%),the overall effectiveness of the treatment(OR2.72,[1.91,3.86] P=0.50 I2=0%)is significant.(5)The combination of acupuncture plus Chinese herbal decoction combined with conventional treatment,acupuncture plus Chinese herbal decoction combined therapy to improve patients with Activity Daily Living Scale(ADL)score(MD-2.81,[-7.41,1.80] P<0.01 I2=96%),Alzheimer's Disease Rating Scale-Cognitive score(ADAS-Cog)score(MD 0.43,[-0.86,1.71] P=0.58 I2=0%)were not significantly improved.(6)Chinese medicine treatment(acupuncture,moxibustion,acupuncture combined with traditional Chinese medicine decoction)compared with conventional treatment,acupuncture plus Chinese herbal decoction combined therapy to improve patient Mini-Mental State Examination(MMSE)score(MD 1.94,[1.40,2.48] P<0.01 I2=79%),overall treatment efficiency(OR3.25,[2.64,3.99] P=0.074 I2=0%),Hamilton Depression Scale Marked(HAMD)results are obvious.(7)Chinese medicine treatment(acupuncture,acupuncture plus Chinese herbal decoction combined)compared with conventional treatment,acupuncture plus Chinese herbal decoction combined treatment to improve the Activity Daily Living Scale(ADL)score(MD-1.29,[-2.82,0.23] P<0.01 I2=95%),Alzheimer's Disease Rating Scale-Cognitive score(ADAS-Cog)score(MD-1.15,[-2.65,-0.35] P=0.04 I2=54%)were not significantly improved.(8)The effect of moxibustion combined with decoction of traditional Chinese medicine and routine treatment is significant in improving the scores of Mini-Mental State Examination(MMSE)scale and overall efficiency in patients with Alzheimer's disease.(9)Compared with conventional treatment,warm acupuncture and moxibustion therapy has a significant effect in improving the treatment efficiency of patients with Alzheimer's disease(OR6.85,[2.23,21.09] P=0.89I2=0%)Conclusion The combination of acupuncture and moxibustion or acupuncture treatment with traditional Chinese medicine decoction therapy has certain advantages in the treatment of Alzheimer's disease.It can improve the overall efficiency of treatment,senile dementia patients simple smart scale(MMSE)score,clinical dementia assessment table(CDR Scores,improved MBI scores,Chinese Dementia Syndrome Rating Scale(SDSD)score,Hasegawa Dementia Scale(HDS)score,and Montreal Cognitive Assessment Scale(Mo CA)score.Acupuncture or acupuncture treatment combined with traditional Chinese medicine decoction therapy can improve patients' symptoms and improve their quality of life.The 45 articles included in the study concluded that overdose was basically a positive result,which may be one of the reasons for publication bias;besides,randomized,controlled,double-blind trials were rare and no third-party evaluations were performed.No follow-up studies have been conducted;and reports on the safety of acupuncture treatment are rarely reported.Therefore,in the future clinical research on this disease,attention should be paid to the evaluation of literature quality,and systematic analysis should be conducted mainly through high-quality clinical studies such as multi-center,large-scale,standardized clinical randomized controlled trials,so as to further acupuncture Treatment of this disease provides more reliable clinical evidence.The conclusions drawn from these conclusions can be referenced by clinicians in clinical practice,and can also provide reference for the next step in basic research. |
PDF Full Text Request