Acupuncture and Related Therapies for the Cognitive Function of Alzheimer’s Disease: A Network Meta-Analysis
-
Xuesong Wang
,
Jia-Jia Li
,
Yue-Shen Wang
,
Chao-Chao Yu
,
Chuan He
,
Zhong-Sheng Huang
,
Tao Jiang
,
Qing Hao
,
Li-Hong Kong
Abstract
Background: Acupuncture and acupuncture-related therapies are effective for Alzheimer's disease (AD), therefore, we aimed to compare and rank the interventions that mainly focus on acupuncture-related therapies in the treatment of patients with mild to moderate AD.
Methods: We used network meta-analysis to evaluate the direct and indirect evidence shown in randomized controlled trials of AD. The data were analyzed using RavMan manager, Stata, and WinBUGS software after two researchers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies.
Results: We analyzed a total of 36 eligible studies, including 2712 patients, involving 14 types of acupuncture-related therapies and comprehensive therapies. For Mini-Mental State Examination (MMSE), acupuncture (ACU) combined with cognitive and memory training (Training) was more effective than ACU, ACU+Chinese herb (CH), ACU+Donepezil (DON), CH, DON, DON+Nimodipine (NIM), Music therapy (Music), NIM, Placebo, and Training (P<0.05), while ACU+CH was batter than CH (P<0.05), and ACU+DON+NIM was better than DON+NIM (P<0.05). For Alzheimer's Disease Assessment Scale-Cognitive section (ADAS-cog), ACU was more effective than DON and placebo (P<0.05). For Activities of Daily Living (ADL), ACU+DON was better than CH, DON, NIM, and Placebo (P<0.05). For the clinical effectiveness rate, ACU, ACU+CH, ACU+CH+DON, ACU+CH+DON+NIM, ACU+DON, CH, NIM were all more effective than DON+NIM (P<0.05), while ACU and ACU+CH were better than DON (P<0.05). The comprehensive ranking results show that ACU+training and ACU have the highest ranking probability.
Conclusion: ACU+Training and ACU may be the best therapies to improve the cognitive function of patients with mild to moderate AD, while the combination of acupuncture-related therapies and other therapies has a higher overall benefit.
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2. Zhang L, Li Z (2014). Alzheimer and the discovery of Alzheimer’S Disease.Zhonghua Yi Shi Za Zhi, 44 (5):288-290.
3. Prince M, Bryce R, Albanese E, et al (2013). The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement, 9 (1):63-75. e62.
4. Nichols E, Szoeke CE, Vollset SE, et al (2019). Global, regional, and national burden of Alzheimer's disease and other dementias, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology, 18 (1):88-106.
5. Livingston G, Sommerlad A, Orgeta V, et al (2017). Dementia prevention, intervention, and care. Lancet, 390 (10113):2673-2734.
6. Kaduszkiewicz H, Zimmermann T, Beck-Bornholdt H-P, et al (2005). Cholinesterase inhibitors for patients with Alzheimer's disease: systematic review of randomised clinical trials. BMJ, 331 (7512):321-327.
7. Lanctôt KL, Herrmann N, Yau KK, et al (2003). Efficacy and safety of cholinesterase inhibitors in Alzheimer's disease: a meta-analysis. CMAJ, 169 (6):557-564.
8. Tricco AC, Soobiah C, Berliner S, et al (2013). Efficacy and safety of cognitive enhancers for patients with mild cognitive impairment: a systematic review and meta-analysis. CMAJ, 185 (16):1393-1401.
9. Wang X, Sun G, Feng T, et al (2019). Sodium oligomannate therapeutically remodels gut microbiota and suppresses gut bacterial amino acids-shaped neuroinflammation to inhibit Alzheimer’s disease progression. Cell Research, 29 (10):787-803.
10. Zhou S, Dong L, He Y, et al (2017). Acupuncture plus herbal medicine for Alzheimer’s disease: a systematic review and meta-analysis. Ame J Chin Med, 45(7):1327-1344.
11. Lin L, Li H, Shi H, et al (2017). acupuncture and moxibustion in the treatment of senile dementia: a meta-analysis. Chinese Journal of Gerontology, 37 (20):5014-5016.
12. Zhou J, Peng W, Xu M, et al (2015). The effectiveness and safety of acupuncture for patients with Alzheimer disease: a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore), 94 (22):e933.
13. Luan K, Gao W, Sun Q, et al (2019). Clinical Ｒesearch Progress of AD Treated by Acupuncture and Moxibustion. Journal of Clinical Acupuncture and Moxibustion, 35 (5):83-86.
14. Hutton B, Salanti G, Caldwell DM, et al (2015). The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health ,care interventions: checklist and explanations. Ann Intern Med, 162(11):777-784.
15. Fleming PS, Koletsi D, Pandis N (2014). Blinded by PRISMA: are systematic reviewers focusing on PRISMA and ignoring other guidelines? PLoS One, 9(5):e96407.
16. Association AP. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR): American Psychiatric Association; 1994.
17. McKhann GM, Knopman DS, Chertkow H, et al (2011). The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement, 7(3):263-269.
18. Tian J. Chinese Guidelines for the Diagnosis and Treatment of Alzheimer’s Disease and Other Dementias. BeiJing: People's Medical Publishing House; 2012.
19. Green S (2011). Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration. Available from: https://training.cochrane.org/handbook.
20. Shim S, Yoon B-H, Shin I-S, et al (2017). Network meta-analysis: application and practice using Stata. Epidemiol Health, 39:e2017047.
21. Stephenson M, Fleetwood K, Yellowlees A (2015). Alternatives To Winbugs for Network Meta–Analysis. Value in Health, 18 (7):A720.
22. Higgins JP, Green S (2008). Cochrane Handbook for Systematic Reviews of Interventions. Journal of Multidisciplinary Evaluation, 6:142-148.
23. Higgins JP, Thompson SG, Deeks JJ, et al (2003). Measuring inconsistency in meta-analyses. BMJ, 327(7414):557-560.
24. Zhang C, Yan J, Sun F, et al (2014). Differentiation and Handling of Homogeneity in Network Meta-analysis. Chinese Journal of Evidence-Based Medicine, 14(7):884-888.
25. Liu Y, Zhang M, Li J (2007). Bayesian econometrics based on WinBUGS software. Journal of East China Institute of Technology (Social Science), 26 (2):101-107.
26. Dias S, Sutton AJ, Ades AE, et al (2013). Evidence synthesis for decision making 2: a generalized linear modeling framework for pairwise and network meta-analysis of randomized controlled trials. Medical decision making : an international journal of the Society for Medical Decision Making, 33 (5):607-617.
27. Salanti G, Ades A, Ioannidis JP (2011). Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. Journal Clin Epidemiol, 64(2):163-171.
28. Chaimani A, Higgins JP, Mavridis D, et al (2013). Graphical tools for network meta-analysis in STATA. PLoS One, 8(10):e76654.
29. Zhu H, Dong K, Wu Y, et al (2010). Effect of "bushenhuoxue" on cognitive function improvement in patients with Alzheimer's Disease. Chinese Journal of Gerontology, 30 (11):1493-1495.
30. Li Z, Mu Y, Ou Y (2002). Clinic control research of Alzheimer's Disease by the combination of acupuncture and Danggui Shaoyao San (DGSYS) of TCM. Modern Rehabilitation, 6 (19):2848-2849.
31. Jiang W, Tian H, Hu J, et al (2018). Effect of "JinSanZhen" Combined with "JianNaoSan" on Cerebral Blood Flow in Patients with Alzheimer's Disease. Jiangxi Journal of Traditional Chinese Medicine (Chinese), 49 (08):51-53.
32. Peng X, Dong K (2009). Clinical observation on acupuncture combined with Yizhi Jiannao granules for treatment of Alzheimer's disease. Zhongguo Zhen Jiu, 29 (4):269-271.
33. Salloway S, Ferris S, Kluger A, et al (2004). Efficacy of donepezil in mild cognitive impairment: a randomized placebo-controlled trial. Neurology, 63(4):651-657.
34. Doi T, Verghese J, Makizako H, et al (2017). Effects of Cognitive Leisure Activity on Cognition in Mild Cognitive Impairment: Results of a Randomized Controlled Trial. J Ame Med Dir Assoc, 18(8):686-691.
35. Lee GY, Yip CC, Yu EC, et al (2013). Evaluation of a computer-assisted errorless learning-based memory training program for patients with early Alzheimer's disease in Hong Kong: a pilot study. Clin Interv Aging, 8:623-633.
36. Li CH, Liu CK, Yang YH, et al (2015). Adjunct effect of music therapy on cognition in Alzheimer's disease in Taiwan: a pilot study. Neuropsychiatr Dis Treat, 11:291-296.
37. Feng Q, Bin L, Zhai Y, et al (2019). Long-term efficacy and safety of electroacupuncture on improving MMSE in patients with Alzheimer's disease. Zhongguo Zhen Jiu , 39(1):3-8.
38. Yan X, Li Z, Hua Q, et al (2014). The effect of Tousanshen acupuncture in the treatment of Alzheimer's disease on plasma Tau protein. Journal of Bengbu Medical College, 39 (03):302-303+306.
39. Gu W, Jin X, Zhang Y, et al (2014). Clinical observation of Alzheimer's disease treated with acupuncture. Zhongguo Zhen Jiu, 34(12):1156-1160.
40. Mu Y, Li Z (2001). The Treatment of Alzheimer 's Disease by the Combination of Acupuncture and Medicine. Shanghai Journal of Acuuncture and Moxibustion, 20 (03):3-5.
41. Zhu C, Cai S, XU B, et al (2015). Clinical Effect of Tongdu Tiaoshen Acupuncture in Treatment of Amnestic Mild Cognitive Impairment. Journal of Anhui University of Chinese Medicine, 34 (03):55-58.
42. Ou Y, Li Z, Mu Y, et al (1999). Clinical study on acupuncture treatment of Alzheimer's disease. Chinese Acupuncture & Moxibustion, 19 (07):15-17+14.
43. Jia Y, Zhang X, Yu J, et al (2017). Acupuncture for patients with mild to moderate Alzheimer’s disease: a randomized controlled trial. BMC Complement Altern Med, 17(1):556.
44. Cheng H, Zhao D (2017). The Clinical Observation of Senile Dementia Treated with Bushen Huoxue Decoction in Combination with Acupuncture. Henan Traditional Chinese Medicine, 37 (04):619-621.
45. Li T, Wan G, Zhang Y (2014). Clinical observation of "BuShenYiNao" acupuncture combined with rehabilitation training in the treatment of senile dementia. Hunan Journal of Traditional Chinese Medicine, 30 (08):104-106.
46. Tang S, Liu S, Zeng P, et al (2014). Clinical Observation of "BuSuiYiNaoTang" Combined with Acupuncture in the Treatment of Alzheimer's Disease. Jiangxi Journal of Traditional Chinese Medicine, 45 (08):47-49.
47. Wang Z, Wang Z (2017). Study on Dihuang Yizhi prescription，electroacupuncture combined with Donepezil Hydrochloride Tablets in the treatment of Alzheimer’s dementia. Modern Journal of Integrated Traditional Chinese and Western Medicine, 26 (30):3331-3333+3337.
48. Yao A, Wang X, Dong L, et al (2016). Observation on the Effect of the Treatment of Alzheimer's Diseases with Rehmannia Decoction Combined Acupuncture at Baihui Point. World Journal of Integrated Traditional and Western Medicine, 11 (05):667-670.
49. Wang K, Zhang L, Chen X (2015). Clinical observation on 36 cases of Alzheimer's disease treated by electro-acupuncture Dazhui (GV 14) and Baihui (GV 20). China Journal of Traditional Chinese Medicine and Pharmacy, 30 (03):784-786.
50. Yang X, Lin D (2015). Clinical study of electroacupuncture combined with "DiHuangYinZi" in Treating Patients with Alzheimer's Disease. Journal of Clinical Acupuncture and Moxibustion, 31 (09):8-10.
51. Liu J (2018). Observation on the efficacy of "JinSanZhen" combined with donepezil hydrochloride and nimodipine in the treatment of dementia. Modern Journal of Integrated Traditional Chinese and Western Medicine, 27 (32):3587-3590.
52. Jia Y, Meng D, Sun M, et al (2017). Clinical Observation of Sanjiao Acupuncture on Mild to Moderate Alzheimer's Disease: A Randomized Controlled Trial. Liaoning Journal of Traditional Chinese Medicine, 44 (09):1911-1914.
53. Lin C, Zhang J, Guo J, et al (2014). Effect of "TiaoShenYiZhi" acupuncture in the treatment of mild Alzheimer's disease .Chinese Journal of Gerontology, 34(08):2225-2226.
54. Zhao L, Ma L, Li Y, et al (2007). Observation on the Effect of acupuncture on the treatment of senile dementia. Journal of Clinical Acupuncture and Moxibustion, (09):42-43.
55. Dai J, Xiao J, Li S, et al (2019). Effect of Acupuncture Combined with Rehabilitation Training on Rehabilitation of Patients with Senile Dementia. Clinical Journal of Traditional Chinese Medicine,31 (02):317-319.
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| Files | ||
| Issue | Vol 50 No 12 (2021) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v50i12.7924 | |
| Keywords | ||
| Acupuncture Alzheimer's disease Cognitive function Network meta-analysis | ||
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How to Cite
1.
Wang X, Li J-J, Wang Y-S, Yu C-C, He C, Huang Z-S, Jiang T, Hao Q, Kong L-H. Acupuncture and Related Therapies for the Cognitive Function of Alzheimer’s Disease: A Network Meta-Analysis. Iran J Public Health. 2021;50(12):2411-2426.
