Use of acupuncture alone or with medication can improve cognitive and memory function in patients with amnestic mild cognitive impairment (MCI), new research suggests. A meta-analysis of five randomized controlled trials (RCTs) and more than 500 patients with MCI and memory deficits showed that those who received acupuncture for 2 to 3 months had a significantly higher clinical efficacy rate than those who received the oral calcium channel blocker nimodipine. The acupuncture group also had greater improvements on a picture recognition test and on the Mini-Mental State Examination (MMSE). In addition, the participants who had acupuncture plus nimodipine showed significantly better scores on the MMSE compared with those taking nimodipine by itself. However, "caution must be exercised given the low methodological quality of included trials," write Min Deng, Department of Neurology at Zhongnan Hospital of Wuhan University, China, and Xu-Feng Wang, Department of General Surgery at Renmin Hospital of Wuhan University. The study authors add that "more rigorously designed studies" are now needed. The findings were published online in the BMJ journal Acupuncture in Medicine. Electroacupuncture Therapy Although interest in the possible use of acupuncture for this type of MCI has been growing, a deep-dive comparison of the intervention vs other treatments "is lacking," note the researchers. They searched seven databases for trials that compared acupuncture with other modalities up to July 2015. The databases included PubMed and MEDLINE, the Chinese Acupuncture Trials Register, and the Chinese National Knowledge Infrastructure. All of the RCTs included in the new meta-analysis were conducted in China and published in 2012 or 2013. There were a total of 568 patients, of whom 288 had been randomly assigned to receive acupuncture. In three of the trials the participants received 30-mg doses of nimodipine three times per day only or acupuncture only, whereas all of the participants in the other two trials received the medication with or without acupuncture. In four of the five studies, 30-minutes sessions of electroacupuncture were conducted three times a week for 2 months. In the fifth study, the intervention was given five times per week for 3 months. The number of participants in the individual studies was small, however, with only 26 to 94 per treatment group. Generalizability Unclear Results from the monotherapy comparison trials showed a combined odds ratio (OR) of 1.78 for clinical efficacy in the acupuncture vs nimodipine groups (95% confidence interval [CI], 1.19 - 2.65; P < .01). In addition, the mean difference in scores was 0.99 (95% CI, 0.71 - 1.28) for the MMSE and 2.12 (95% CI, 1.48 - 2.75) for picture recognition (both comparisons, P < .01). The mean difference in MMSE scores for the acupuncture with nimodipine group vs the nimodipine alone group was 1.09 (95% CI, 0.29 - 1.89; P < .01). Finally, in the three trials that reported on adverse events, errhysis at needle sites and fainting were associated with acupuncture, while mild headaches and gastrointestinal reactions were associated with nimodipine. "Overall, our meta-analysis suggests that acupuncture was a useful therapy in improving cognitive function," write the investigators. However, the studies' methodological quality "was judged to be generally poor because there was high or unclear risk of bias," they add. Other problems cited included that three of the trials did not detail how they achieved random sequence generation and one trial did not achieve true randomization because it used visiting time points. There were also no reports of "allocation concealment or blinding assessment." There also may have been a placebo effect, which was not controlled for, because of the possibility that Chinese patients may prefer acupuncture instead of medications. "Therefore, rigorous clinical studies in Western settings should be considered before extrapolating the results to other populations," the researchers conclude. Source
