| Objective Alzheimer’s disease(AD),with its insidious and irreversible onset,has become one of the most important medical and social problems worldwide,along with the increasing aging of the world.In recent years there is increasing evidence showing that acupuncture-related therapies are effective in AD,and our aim was to compare the clinical efficacy of different acupuncture-related therapies in patients with mild to moderate AD and to rank the included interventions.MethodsWe used Network Meta-Analysis(NMA)to evaluate the direct and indirect evidence from the included studies.Four English and four Chinese databases were searched for clinical randomized controlled trials(RCTs)using acupuncturerelated therapies as the primary intervention for the treatment of patients with early to mid-stage AD,with the search period from database creation to February 25,2021,and the language of publication limited to Chinese or English.After two researchers independently screened the literature,extracted data,and assessed the risk of bias for the included studies,the data were analyzed using Review Manager5.4,Stata 15.0,and Win BUGS 1.4.3 software.Result We analyzed a total of 36 eligible studies,including 2711 patients,involving 14 types of acupuncture-related therapies and comprehensive therapies.The NMA results show that: for Mini-Mental State Examination(MMSE),acupuncture(ACU)combined with cognitive and memory training(Training)was more effective than ACU,ACU + Chinese herb(CH),ACU +Donepezil(DON),CH,DON,DON + Nimodipine(NIM),Music therapy(Music),NIM,Placebo,and Training(P < 0.05),while ACU + CH was batter than CH(P < 0.05),and ACU + DON+ NIM was better than DON + NIM(P < 0.05).For Alzheimer’s Disease Assessment Scale-Cognitive section(ADAS-cog),ACU was more effective than DON and placebo(P < 0.05).For Activities of Daily Living(ADL),ACU + DON was better than CH,DON,NIM,and Placebo(P < 0.05).For the clinical effectiveness rate,ACU,ACU + CH,ACU + CH + DON,ACU + CH+ DON + NIM,ACU + DON,CH,NIM were all more effective than DON + NIM(P < 0.05),while ACU and ACU + CH were better than DON(P < 0.05).The comprehensive ranking results show that ACU + training and ACU have the highest ranking probability.Conclusion(1)ACU + Training may be the best treatment for improving MMSE scores in patients with mild to moderate AD;(2)ACU may be most helpful for improving ADAS-cog scores and ADL scores in patients with mild to moderate AD.(3)The overall benefit of acupuncture-related therapy in combination with other therapies is higher in patients with mild-to-moderate AD compared with monotherapy.(4)Compared with pharmacotherapy alone,acupuncture-related therapies have lower rates of adverse effects and are safer.Therefore,among the included interventions,ACU + Training and ACU may be the best therapy to improve cognitive function in patients with mild to moderate AD. |
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