Vascular cognitive impairment (VCI) is the second most common cause of dementia in the world, resulting from cumulative cerebrovascular lesions from infarcts, leukoaraiosis, and chronic hypoperfusion. Unlike Alzheimer’s disease, VCI has well-defined modifiable risk factors — hypertension, diabetes, atrial fibrillation, smoking — and its progression can be delayed with adequate control. However, specific pharmacologic options for vascular cognition are limited, and cholinesterase inhibitors have marginal efficacy in this population. A meta-analysis published in Translational Psychiatry (Nature Publishing Group) in August 2024 evaluated electroacupuncture as an adjunctive intervention in mild VCI, bringing together 15 randomized clinical trials and 1,033 participants.
The study was conducted by Shen M, Zhang L, Li C, and colleagues. The analysis included patients with a diagnosis of mild vascular cognitive impairment (VaMCI — Vascular mild Cognitive Impairment), assessed by validated scales such as the MoCA (Montreal Cognitive Assessment), the MMSE (Mini-Mental State Examination), and the ADL index (Activities of Daily Living). An important methodologic differential of this study was the application of Trial Sequential Analysis (TSA), which determines whether the cumulative number of patients in the studies is already sufficient to confirm the conclusions or whether more trials are needed — an approach that reduces the risk of premature conclusions in meta-analyses.
MAIN RESULTS — 15 RCTS, 1,033 PARTICIPANTS
What is Trial Sequential Analysis (TSA) and why does it matter?
Trial Sequential Analysis (TSA) is an advanced statistical method that applies cumulative monitoring boundaries to meta-analyses — similar to the stopping boundaries used in individual trials with interim analyses. In practical terms, the TSA determines whether the accumulated evidence has already crossed the "required information size" (RIS) threshold: the minimum number of participants needed to confirm a result with adequate statistical power. When the TSA confirms the conclusions — as in this study — it means that new trials should not alter the direction of the findings, only refine the effect estimate. This is particularly relevant in áreas where there is suspicion of publication bias or where studies have small samples that could artificially inflate positive effects.
MoCA and MMSE results: clinical relevance
The MoCA and MMSE are the most widely used cognitive screening instruments in neurologic practice. The MoCA is more sensitive for mild VCI — it evaluates domains specifically compromised in VCI such as executive attention, verbal fluency, and abstraction, in addition to episodic memory. An improvement of 1-2 points on the MoCA in the context of VaMCI is clinically relevant because it may represent the difference between "mild cognitive impairment" and normal cognitive function (usual cutoff: 26/30). The MMSE, although less sensitive for VCI, evaluates global cognition and guides functional capacity decisions. The simultaneous improvement in MoCA, MMSE, and ADL in this meta-analysis suggests that the benefits of electroacupuncture are not limited to performance on standardized tests — they translate into real functional gains for the patient.
Frequently Asked Questions
Vascular cognitive impairment (VCI) results from cerebrovascular lesions — lacunar infarcts, leukoaraiosis, chronic hypoperfusion — that damage the white-matter networks responsible for processing speed, executive attention, and frontal functions. Alzheimer’s is a primary degeneration of cortical neurons due to amyloid and tau accumulation. VCI tends to have a more abrupt onset (after stroke) or stepwise progression, relative preservation of episodic memory, and prominent impairment of attention and executive functions. Alzheimer’s typically begins with episodic memory loss and gradual progression. The two can coexist (mixed dementia) — a very common situation in older adults with stroke.
This meta-analysis demonstrates improvement of existing cognitive deficits, but there are not enough data on the prevention of progression to dementia. Long-duration studies (2-5 years) with serial neuroimaging would be needed to answer this question. What can be stated with reasonable certainty is that electroacupuncture, by reducing neuroinflammation and promoting neuroplasticity, creates more favorable conditions for cognitive maintenance. Control of cardiovascular risk factors remains the intervention with the greatest evidence for preventing progression.
Yes — electroacupuncture has an excellent safety profile in older adults, including those on anticoagulants (warfarin, apixaban, rivaroxaban), antihypertensives, statins, and antidiabetics. The main precautions include: avoiding currents near cardiac pacemakers (use points distant from the chest or coordinate with the cardiologist), using lower current intensity in patients with peripheral neuropathy (lower sensitivity to discomfort), and more frequent monitoring of patients on anticoagulation to avoid hematomas at puncture points. The technique is generally well tolerated and does not interfere with usual cardiovascular medications.
Fonte Original
Translational Psychiatry(em inglês)Founded 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).