Acupuncture for mild cognitive impairment in elderly people: Systematic review and meta-analyses

This systematic review and meta-analysis examined the efficacy of acupuncture in the treatment of mild cognitive impairment (MCI) in older adults, a condition that affects approximately 5-10% of the elderly population and may progress to dementia. MCI represents an intermediate state between normal aging and Alzheimer's disease, characterized by cognitive decline in domains such as attention, memory, visuospatial function, language, and executive function. The researchers conducted a comprehensive search of 8 electronic databases, identifying 15 randomized controlled trials that included 1,051 elderly participants (over 60 years old) with MCI. The intervention group (530 participants) received acupuncture alone or combined with other therapies, while the control group (521 participants) received conventional treatment with medications such as donepezil, nimodipine, or cognitive therapy.

The most commonly used acupuncture points included GV-20 (Baihui), EX-HN1 (Sishencong), ST-2 (Sibai), GB-20 (Fengchi), among other points traditionally associated with cognitive enhancement. Treatment duration ranged from 1 to 3 months, with sessions of approximately 30 minutes. Results demonstrated that acupuncture was significantly superior to conventional treatment across multiple cognitive assessment measures. The clinical efficacy rate showed an odds ratio of 2.52 (95% CI 1.86-3.42), indicating that patients treated with acupuncture were more than twice as likely to show clinical improvement.

On the Mini-Mental State Examination (MMSE), the mean difference was 1.53 points (95% CI 1.04-2.01) in favor of acupuncture. On the Montreal Cognitive Assessment (MoCA), the improvement was even more pronounced, with a mean difference of 2.05 points (95% CI 1.17-1.92). The Clock Drawing Test showed a mean difference of 1.91 points (95% CI 1.74-2.08). Subgroup analysis revealed that 2-month treatments showed the best results, suggesting that there is an optimal intervention period.

Acupuncture proved particularly effective when combined with pharmacotherapy, suggesting a synergistic effect that may enhance the absorption and efficacy of medications. Regarding safety, only 8 of the 15 studies reported adverse events, and most found no significant side effects. Some participants reported mild discomfort during the procedure, but no serious adverse events were documented. Bias analysis through funnel plot showed relatively symmetrical distribution, indicating low risk of publication bias.

The clinical implications are significant, as acupuncture offers a non-pharmacological therapeutic alternative for older adults with MCI, a population often vulnerable to the side effects of medications. The therapy proved especially beneficial for improving global cognitive function, working memory, attention, and executive function. The proposed mechanism of action includes modulation of neurotransmitters, improvement of cerebral blood flow, and neuroplasticity. This study represents the first meta-analysis specific to the elderly population with MCI, filling an important gap in the literature.

The findings support the inclusion of acupuncture as a complementary therapy in the management of MCI in older adults, especially considering its favorable safety profile and potential to delay progression to dementia.