Acupuncture on vascular cognitive impairment associated with cerebral small vessel disease: A Systematic Review and Meta-analysis of Randomized and Non-randomized controlled trials

Abstract Introduction: Cerebral small vessel disease (CSVD) is the most common cause of vascular cognitive impairment (VCI). Acupuncture has been used as a treatment approach to alleviate the symptoms caused by VCI. The aim was to conduct a systematic review and meta-analysis to evaluate the efficacy of acupuncture on VCI associated with CSVD. Methods: Twelve English and Chinese databases were searched for relevant studies published between 11 September 2004 to 11 March 2021. Primary outcome was cognitive function assessment. The methodological quality of the studies was assessed and a meta-analysis was undertaken to aggregate the effects of acupuncture. Results: All studies were assessed as having a high risk of bias. Meta-analysis revealed that acupuncture appeared demonstrate improvements in cognitive assessment compared with controls (health education, western medications, Chinese herbal medicine, rehabilitation program or hyperbaric oxygen therapy), MoCa score (MD=3.5, 95% CI 2.81 to 4.19) and MMSE score (MD=2.37, 95% CI 1.26 to 3.49). The review also showed that both conventional acupuncture and electro-acupuncture could be beneficial. Conclusion: Although this review suggests that acupuncture could be an effective treatment for VCI associated with CSVD, there is a very high potential for bias and results should be carefully interpreted.