Vascular cognitive impairment (VCI) is a heterogeneous condition that ranges from mild subjective cognitive deficits due to silent cerebrovascular lesions to established vascular dementia — the second most common form of dementia after Alzheimer disease. With accelerated population aging and the global prevalence of cardiovascular risk factors, VCI represents a growing public health challenge. While specific pharmacologic options for VCI remain limited, acupuncture has been progressively studied as an adjunct intervention. A network meta-analysis published in Frontiers in Aging Neuroscience in June 2025 systematically compared four acupuncture modalities for VCI — including scalp acupuncture, electroacupuncture, manual acupuncture, and auriculotherapy — as adjuncts to standard care with or without pharmacotherapy.
The study used Bayesian random-effects analysis to compare the four acupuncture modalities, in isolation and in combination with pharmacotherapy (cholinesterase inhibitors, memantine, nimodipine) and standard care (vascular risk factor control, cognitive rehabilitation). Primary outcomes were assessed using the MoCA and MMSE scales, with scores standardized in SMD (Standardized Mean Difference). The SUCRA ranking was calculated for each modality/combination, identifying which intervention offered the highest probability of being the most effective.
NMA RESULTS — ACUPUNCTURE MODALITIES FOR VCI
Scalp acupuncture: the modality with the greatest cognitive impact
Scalp acupuncture (scalp acupuncture) — also termed craniopuncture in the scientific literature — is a modality that inserts needles into the subcutaneous tissue of the scalp at specific zones that correspond topographically to the functional áreas of the underlying cerebral córtex. The combination of scalp acupuncture with pharmacotherapy and standard care (SA+P+SC) reached SMD = 2.04 (CI 1.21–2.86) compared with standard care alone — an effect magnitude classified as “very large” by Cohen’s taxonomy (d>0.8). This result places scalp acupuncture as the most effective modality among the four evaluated, surpassing conventional electroacupuncture, manual acupuncture, and auriculotherapy in the context of VCI.
The synergistic effect of the triple combination
One of the most relevant findings of this NMA is that the triple combination (scalp acupuncture + pharmacotherapy + standard care) surpassed any modality in isolation or any double combination. The SMD of 2.04 — almost three times greater than the threshold of clinical relevance of 0.5 — suggests real synergy among the three components. Pharmacotherapy (nimodipine, cholinesterase inhibitors) acts on the molecular mechanisms of vascular injury and cholinergic transmission. Standard care (blood pressure control, anticoagulation, cognitive rehabilitation) stabilizes disease progression. Scalp acupuncture, by improving cerebral perfusion and promoting neuroplasticity, creates a neurophysiological environment more responsive to other treatments — a potentiating effect that explains the superior result of the triple combination. This pattern of therapeutic synergy is increasingly recognized in the integrative medicine literature.
Frequently Asked Questions
“Scalp acupuncture” is the established technical term for the needling technique applied to functional zones of the scalp, mapping cortical projections according to the systems of Jiao Shunfa (China, 1970), Yamamoto (Japan, 1973), and Zhu Ming-Qing (USA). “Craniopuncture” is also acceptable in academic contexts. The reviewed meta-analysis predominantly used the Jiao Shunfa system, with needling of the Upper Motor, Upper Sensory, and Balance lines for cognitive rehabilitation after stroke.
No — the needles in scalp acupuncture are inserted only into the subcutaneous tissue of the scalp, between skin and skull, never penetrating bone or brain. The scalp is relatively thick (4–8 mm), and the needles are inserted at an angle of 10–15°, remaining in the subcutaneous plane. The technique is safe when performed by a trained physician, with the main risk being local hematoma (the scalp is highly vascularized) — controlled with adequate pressure after withdrawal. In anticoagulated patients, the technique can be performed with very fine needles (0.20 mm) and extended pressure after the procedure.
For patients with VCI from ischemic stroke, scalp acupuncture can generally be started after clinical stabilization — usually in the first week after the stroke, when the patient is no longer at risk of lesion extension and is hemodynamically stable. For hemorrhagic stroke, it is usually 2–4 weeks after resolution of active bleeding (confirmed by CT scan). The early window is favorable because post-injury neuroplasticity is at its peak in the first weeks. The physician responsible for the admission should be consulted before starting, especially regarding anticoagulation and tolerance to positioning for the session.
Fonte Original
Frontiers in Aging Neuroscience(em inglês)Estudo Científico
DOI: 10.3389/fnagi.2025.1559388Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).