Acupuncture Therapy for Cognitive Impairment: A Delphi Expert Consensus Survey

Cognitive impairment is a neurological condition that affects millions of people worldwide and represents one of the greatest public health challenges of our time. With the aging of the global population, the number of people affected is expected to double every two decades, potentially exceeding 100 million cases by 2050. The main causes of this impairment include Alzheimer disease and cerebrovascular problems. Although approved medications such as donepezil and memantine exist, their effects vary among patients and may cause adverse effects with prolonged use.

Acupuncture emerges as a promising therapeutic alternative, having been widely used in China for more than three thousand years to treat various neurological conditions. However, to date there are no established guidelines on how to apply acupuncture in a standardized way for the treatment of cognitive impairment.

To fill this gap, Chinese researchers conducted a study to develop practical recommendations based on the consensus of acupuncture experts. The main objective was to provide actionable guidance for acupuncturists who address real clinical questions in the treatment of patients with cognitive impairment. The methodology used was the Delphi technique, a structured scientific process that allows expert opinions to be collected in a controlled and systematic manner, without the need for in-person meetings. Initially, 47 experienced acupuncturists participated in an investigation of the most relevant clinical questions, resulting in 24 items for evaluation.

In parallel, the researchers conducted a comprehensive search of the scientific literature, identifying 11 systematic reviews on acupuncture for cognitive impairment. A panel of 30 highly qualified experts, including senior physicians and researchers from various regions of China, was then invited to evaluate each item through two rounds of voting, expressing agreement, neutrality, or disagreement with each proposition.

The results showed a high degree of agreement among the experts. In the first round, 16 of the 24 items reached consensus, while five controversial items were re-evaluated in the second round, all subsequently reaching consensus. Only three items failed to reach the minimum 80% agreement level established by the study. In total, 21 items reached final consensus, with 10 obtaining agreement between 90% and 100% of the experts, and 11 items reaching agreement between 80% and 90%.

The consensus recommendations were organized into six main categories: therapeutic effects of acupuncture, therapeutic principles, selection and combination of acupuncture points, technical treatment parameters, recommended combined therapies, and possible adverse events. Among the main findings, the experts agreed that acupuncture is recommended for patients with mild-to-moderate cognitive impairment caused by Alzheimer disease or cerebrovascular problems and may improve cognitive functions such as memory and attention, as well as patients' quality of life.

The clinical implications of this consensus are significant for both professionals and patients. For acupuncturists, the study provides practical guidelines on how to conduct treatment, including specific recommendations on which acupuncture points to use (such as Baihui, Sishencong, and Shenting), how many points to apply per session (7 to 9 points), how long to retain the needles (30 to 60 minutes), how often to perform the treatment (3 to 5 times per week), and the total duration of treatment (3 months). For patients, these recommendations offer hope for a safe and potentially effective therapeutic approach, especially important for those who experience adverse effects with conventional medications or are in early stages of cognitive impairment when no approved medications are yet available. The consensus also indicates that acupuncture presents a low risk of adverse events, generally limited to subcutaneous hematomas or abnormal sensations at the application site.

Additionally, the experts recommend combining acupuncture with cognitive training and other traditional Chinese medicine therapies to enhance therapeutic outcomes.

Despite its important contributions, the study has limitations that should be considered. The main limitation is that only Chinese experts participated in the research, which may limit the applicability of the recommendations to other cultural contexts and health care systems. In addition, many of the recommendations were based primarily on the clinical experience of the experts, since the available scientific evidence on acupuncture for cognitive impairment is still limited and of low to very low methodological quality. It is important to recognize that the consensus represents expert opinions at a specific moment and may be modified as new scientific evidence emerges.

The study also did not include the patient perspective, focusing only on the view of professionals. Therefore, although this consensus provides valuable guidelines for the clinical practice of acupuncture in the treatment of cognitive impairment, the authors emphasize the urgent need for more rigorous clinical research to validate these recommendations and establish protocols based on robust scientific evidence. This work represents an important step toward standardizing the use of acupuncture in this condition, but it should be viewed as a starting point for further, more in-depth scientific investigations.