Efficacy of acupuncture and pharmacological therapies for vascular cognitive impairment with no dementia: a network meta-analysis

Ruiyu Li; Congcong Xu; Pengyu Zhong; Ke Wang; YinXiang Luo; Lingyong Xiao; Xiaoyu Dai; Jingxian Han; Xuezhu Zhang

doi:10.3389/fnagi.2023.1181160

Efficacy of acupuncture and pharmacological therapies for vascular cognitive impairment with no dementia: a network meta-analysis

Front Aging Neurosci. 2023 Jun 15:15:1181160. doi: 10.3389/fnagi.2023.1181160. eCollection 2023.

Authors

Ruiyu Li^{1

2}, Congcong Xu^{1

2}, Pengyu Zhong³, Ke Wang^{1

2}, YinXiang Luo^{1

2}, Lingyong Xiao^{1

2}, Xiaoyu Dai^{1

2}, Jingxian Han^{1

2}, Xuezhu Zhang^{1

2}

Affiliations

¹ Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
² National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
³ Department of Cardiology, Nanchong Central Hospital, Nanchong, China.

Abstract

Background and objective: Vascular cognitive impairment with no dementia (VCIND) is considered to be the prodromal stage of vascular dementia, characterized by insidious onset. Although acupuncture and drug therapies are effective, the optimal therapy for VCIND remains to be further determined. Therefore, we conducted a network meta-analysis to compare the effectiveness of acupuncture therapies and current common medicines for VCIND.

Methods: We searched eight electronic databases to identify eligible randomized controlled trials of patients with VCIND treated by acupuncture or drug therapies. The primary outcome was Montreal Cognitive Assessment, and the secondary outcome was Mini-Mental State Examination. We conducted the network meta-analysis within a Bayesian framework. Weighted mean difference with 95% confidence intervals were applied as effect sizes to continuous data for all outcomes. Sensitivity analysis was done to assess the robustness of the findings, and we also carried out a subgroup analysis based on age. We assessed the risk of bias using the Risk of Bias 2.0 tool and applied the Grade of Recommendation Assessment, Development and Evaluation (GRADE) to assess the quality of the outcomes. This study was registered with PROSPERO, number CRD42022331718.

Results: A total of 33 studies with 14 interventions were included, including 2603 participants. In terms of the primary outcome, manual acupuncture plus herbal decoction was considered to be the most effective intervention (P = 91.41%), followed by electroacupuncture (P = 60.77%) and manual acupuncture plus piracetam (P = 42.58%), whereas donepezil hydrochloride ranked the least efficacious intervention (P = 54.19%). For the secondary outcome, electroacupuncture plus nimodipine was considered to be the most effective intervention (P = 42.70%), followed by manual acupuncture plus nimodipine (P = 30.62%) and manual acupuncture (P = 28.89%), whereas nimodipine ranked the least efficacious intervention (P = 44.56%).

Conclusion: Manual acupuncture plus herbal decoction might be the most effective intervention for VCIND. The combination of acupuncture and drug therapy had a tendency to perform better than monotherapy in terms of clinical outcomes.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=331718, identifier: CRD42022331718.

Keywords: acupuncture; efficacy; network meta-analysis; pharmacological therapy; vascular cognitive impairment with no dementia.

Publication types

Systematic Review

Grants and funding

This study was supported by National Natural Science Foundation of China (NSFC) project Effect and mechanism of acupuncture regulating CTLA-4/CD28 synergistic stimulation pathway to maintain peripheral Treg steady state and improve VD neuroinflammatory reaction (82174492), NSFC project Study on the mechanism of glucose metabolism associated with brain function in the group of acupuncture points of Benefiting Qi, Regulating Blood, and Fostering Benevolence (30630074), and Science and Technology of Tianjin Key R&D Plan Early Diagnosis of Vascular Mild Cognitive Impairment, Establishment of Early Warning System and Study of Acupuncture Efficacy (20YFZCSY00810).