| Obj ective:To investigate the role of acupuncture in the treatments of dementia.By analyzing the clinical studies on acupuncture treating dementia,we summarized the influence of acupuncture therapy on patient quality of life(QoL),cognitive function(CoF),and side effects,to sum up the rules of acupoint selection.Methods:We searched the online databases(CNKI,Wanfang databases,VIP databases,P UBMED,ScienceDirect,and Cochrane Library),and performed reference tracing.Randomized controlled trials(RCTs)and quasi-RCTs compared acupuncture with non-acupuncture(NA)for dementia were identified.We looked up the clinical trial registrations in the International Clinical Trials Registry Platform(ICTRP)and the Cochrane central register of controlled trials(CENTRAL).We searched for grey literature in the Sciencepaper Online and the Open Grey.Studies that met the inclusion and exclusion criteria were included,regardless of language and publish date.Primary outcomes were CoF(assessed by mini-mental state examination(MMSE)),QoL(assessed by activity of daily living scale(ADL)),and the events of falling and losing.Secondary outcomes were other scales for QoL(Barthel index(BI),modified Barthel index(MBI),functional activities questionnaire(FAQ),etc.),for CoF(Montreal cognitive assessment(MoCA),Hasegawa dementia scale(HDS),Alzheimer’s disease assessment scale-Cognitive section(ADAS-Cog),Loewenstein occupational therapy cognitive assessment(LOTCA),Blessed dementia scale(BDS),etc.),and side effects.The meta-analysis,cluster-analysis,non-parametric test,chi-square test(including the Fisher’s precision probability test),and generalized linear model were performed to assess the curative effect,safety,and acupoint selection.Statistical analyses were performed using the following:IBM SPSS Statistics 26.0,ASA Visual Statistics,GraphPad Prism 8,and Review Manager 5.4.In the meta-analysis,continuous outcomes were represented by MD,dichotomous outcomes were represented by OR,time-to-event was represented by Peto OR,95%confidence interval(CI)of these outcomes were calculated.The risk of bias and quality of evidence(QoE)was checked by the Cochrane bias tool and the GRADE approach.α(type Ⅰ error)and β(type Ⅱ error)were 0.05 and 0.10 respectively.Results:Until December 2020,3 692 reports and 44 clinical trial registrations were searched.Finally,4 5 reports for 43 studies involved 3251 participants,published from 2004 to 2020 were included.For primary outcome,acupuncture improved CoF(MMSE:MD 2.00,95%CI 1.66-2.33,I2=61%,35 studies,2512 participants)and QoL(ADL:MD 3.13,95%CI 2.36-3.91,I2=48%,25 studies,1841 participants)compared with NA.No data described negative events of falling and losing.Subgroup analysis revealed that the difference in acupuncture methods was the main source of heterogeneity.All three methods,manual acupuncture(MA)(MMSE:MD 1.61,95%CI 1.39-1.83,I2=29%,27 studies,1817 participants;ADL:MD 2.70,95%CI 2.12-3.26,I2=35%,21 studies,1400 participants),low-frequency electroacupuncture(EA)(<50Hz)(MMSE:MD 2.19,95%CI 1.64-2.75,I2=0%,5 studies,428 participants;ADL:MD 2.61,95%CI 1.15-4.08,I2=14%,2 studies,296 participants)and high-frequency EA(≥50Hz)(MMSE:MD 3.88,95%CI 3.25-4.39,I2=0%,5 studies,267 participants;ADL:MD 5.76,95%CI 4.16-7.35,I2=0%,3 studies,145 participants)improved CoF and QoL compared with NA.High-frequency EA was more effective than MA(MMSE:χ2=50.25,P<0.01;ADL:χ2=12.56,P<0.01)and low-frequency EA(MMSE:χ2=1 6.1 5.P<0.01;ADL:x2=8.08,P<0.01).For secondary outcome,acupuncture improved MoCA(MD 2.54,95%CI 0.66-4.42,I2=96%,7 studies,478 participants),HDS(MD 1.75,95%CI 0.94-2.56,I2=61%,8 studies,540 participants),ADAS-Cog(MD 2.48,95%CI 1.50-3.47,I2=0%,5 studies,350 participants),LOTCA(MD 8.36,95%CI 3.05-13.67,1 study,60 participants),BI(MD 6.44,95%CI 4.33-8.56,I2=0%,3 studies,232 participants),MBI(MD 1 1.96,95%CI 9.50-14.42,I2=0%,4 studies,334 participants)and FAQ(MD 1.39,95%CI 0.75-2.03,I2=0%,4 studies,334 participants)compared with NA.There was no or little difference between acupuncture and NA on safety(OR 0.91,95%CI 0.45-1.84,I2=0%,9 studies,937 participants)and patients compliance(OR 0.90,95%CI 0.59-1.38,I2=0%,11 studies,1130 participants).In addition,acupuncture may have positive effects on mental behavioral symptoms,depression,event-related potential P300 latency,blood Aβ1-42 protein,blood Aβ pre-protein,and blood somatostatin compared with NA.The mean number of acupoints of dementia therapy was 7 and the course was 8 weeks,Baihui(DU20)and projection of frontopolar area of scalp acupuncture(FASA)had positive impacts on CoF.Taixi(KI3),DU20,and FASA all had positive impacts on QoL.Conclusions:Acupuncture therapy was effective in improving CoF and QoL in patients with dementia(moderate QoE)in short-term,with EA(≥50Hz)was the most effective(low QoE).In terms of safety and patients compliance,there was no or little difference between acupuncture and NA(low QoE).Acupuncture may have potential benefits for mental and behavioral symptoms,psychological status,and physical and chemical indicators such as event-related potential P300 latency,blood Aβ1-42 protein,blood Aβ pre-protein,and blood somatostatin(moderate to low QoE).Acupuncture showed a valuable long-term effect,and the specific effect needs to be studied in the future.Using FASA,DU20,and KI3 as primary acupoints for the well-being of patients.The suggested number of acupoints used was 2-14,additional acupoints could be adjusted in line with differentiation of pattern.The course of treatment should be less than 14 weeks.Registration:CRD42020 1 89948(PROSPERO). |
PDF Full Text Request