Abstract
Background: The effects of acupuncture on Alzheimer's disease (AD) outcomes remain controversial. The aim of this review was to evaluate the effectiveness and safety of acupuncture for the treatment of AD.Methods: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, Chinese BioMedical Literature Database, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang Data were searched to identify relevant randomized controlled trials from inception to January 19, 2019. Data were extracted and evaluated by two authors independently. The data analysis was conducted using R (version 3.6.0) and RStudio (version 1.2.1335) software.Results: Thirty trials involving 2,045 patients were included. Acupuncture plus drug therapy may have been more beneficial for general cognitive function in AD patients than drug therapy alone (short-term treatment: MD, mean difference = 1.94, 95% CI: 1.11, 2.77; p < 0.01; medium-term treatment: MD = 4.41, 95% CI: 1.83, 7.00; p < 0.01). People who received acupuncture plus drug therapy attained higher ADL (Activities of Daily Living) scores than patients who received drug therapy alone for medium-term treatment duration (MD = −2.14; 95% CI: −3.69, −0.59; p < 0.01). However, there is no statistically significant difference in subgroup effect on MMSE (Mini-mental Status Examination) and ADLs (p > 0.05) when comparing acupuncture treatment with drug therapy (such as Donepezil hydrochloride, Nimodipine, or Yizhijiannao), or acupuncture plus drug therapy (such as Donepezil hydrochloride, Dangguishaoyaosan, or Jiannaosan) with drug therapy alone. There was also no significant difference in general cognitive function, ADLs, or incidence of adverse events between acupuncture treatment and drug therapy (p > 0.05).Conclusions: This review indicates that acupuncture plus drug therapy may have a more beneficial effect for AD patients than drug therapy alone on general cognitive function in the short and medium term and on ADLs in the medium term. Acupuncture alone may not have superior effects compared with drug therapy on global cognitive function, ADLs, and incidence of adverse events. Duration of treatment may not modify the effect of acupuncture in comparison with drug therapy. Additional large-scale and high-quality clinical trials are needed.
Highlights
Dementia is a progressive global cognitive impairment syndrome
There was a statistically significant difference with medium-term treatment (MD = 1.26; 95% confidence interval (CI): 0.25, 2.28; p = 0.01; see Figure 3), as Figures 4, 5 show, there is evidence of a publication bias with regard to the minimental status examination (MMSE) results when comparing the effect of acupuncture with drug therapy in the medium term (p = 0.048 for Egger’s test, asymmetric funnel plot)
The main finding of our review suggests acupuncture plus drug therapy may be more beneficial for Alzheimer’s disease (AD) patients than drug therapy alone in the areas of general cognitive function in the short term and medium term, and activities of daily living (ADL) skills in the medium term
Summary
Dementia is a progressive global cognitive impairment syndrome. It is estimated that the number of dementia patients worldwide is 35.6 million, and this is expected to double every 20 years and reach 115.4 million by 2050 (World Health Organization, 2013). Alzheimer’s disease (AD) is the most common form of dementia, comprising at least 60% of cases; it is characterized by progressive memory deficits, spatial disorientation, and other neuropsychiatric disorders (Herrup, 2011; Thies and Bleiler, 2011). Rivastigmine, and galantamine are commonly recommended (Birks, 2005). None of these drugs can stop the progression of AD, and their therapeutic effects vary from person to person and are limited to the duration of treatment (Alzheimer’s Association, 2017). Adverse events such as nausea, vomiting, and dizziness have been reported to be associated with drug therapy for AD patients (Kobayashi et al, 2016). The effects of acupuncture on Alzheimer’s disease (AD) outcomes remain controversial.
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