Clinical effects of acupuncture therapy for vascular dementia

OBJECTIVE: To evaluate clinical acupuncture treatment studies for vascular dementia, as well as to collect high-quality evidence related to clinical acupuncture treatment for clinical diagnosis. DATA SOURCES: PubMed database (1966-2010), Embase database (1986-2010), Cochrane Library (Issue 1, 2010), Chinese Biomedical Literature Database (1979-2010), China HowNet database (1979-2010), VIP Journals Database (1989-2010), and Wanfang database (1998-2010) were analyzed by computer. DATA SELECTION: Any form of acupuncture (needles, electro-acupuncture, laser acupuncture, pointer, or ear acupuncture), as well as blank, placebo, Western medicine, acupuncture therapy combined with other therapies, and randomized or quasi-randomized controlled studies were included. The priority was given to high-quality randomized, controlled trials. Data were independently extracted from two reviewers and cross-checked in accordance with high to low standards utilizing evidence-based medicine to answer five relevant clinical questions. Statistical outcome indicators were measured using RevMan 5.0.20 software, such as overall function, Hasegawa Dementia Scale score, Functional Activities Questionnaire score, Mini Mental State Examination, and efficacy of daily living activities. MAIN OUTCOME MEASURES: The present study assessed standards of efficacy, including Hasegawa Dementia Scale score, Functional Activities Questionnaire score, Mini Mental State Examination, and efficacy of daily living activities. RESULTS: A total of 11 articles were included, including one with systematic reviews/meta-analysis, one with Cochrane A level, eight with Cochrane B level, and one with Cochrane C level evidence. Acupuncture resulting in improved overall function and cognitive function was superior than Western medicine. A system evaluation showed the following: weighted mean difference (WMD) = 5.64, 95% confidence interval (CI): 2.87-11.09, P < 0.01; WMD = 6.07, 95% CI: 3.76-8.38, P < 0.01. Two articles with Class B evidences revealed efficacy at different aspects of acupuncture and moxibustion, which was superior to the conventional body acupuncture group (risk ratio (RR) = 0.03, 95% CI: 0.01-0.18, P < 0.01; RR = 0.05, 95% CI: 0.07-0.13, P < 0.05). One A-level evidence study demonstrated that acupuncture improved mental state, daily living activities, and efficacy and effect of cognitive aspects, which was superior to the drug group [cognitive effects (RR = 5.92, 95% CI: 2.66-13.16, P < 0.01); activities of daily living efficacy (RR = 3.00, 95% CI: 1.57-5.75, P < 0.01)]. The Mini Mental State Examination score resulted in the following: WMD = 3.85, 95% CI: 1.63-6.07, P < 0.01. One B-grade evidence article revealed that laser irradiation combined with electro-acupuncture was more effective than simple drug treatment (RR = 10.43, 95% CI: 1.22-89.46, P < 0.05). CONCLUSION: The inclusion of limited clinical studies has verified the efficacy of acupuncture in vascular dementia treatment. Acupuncture or its combination with Chinese herbs provides certain advantages, but most clinical studies have a small sample size. Large sample size, randomized, controlled trials are needed in the future for more definitive results.