Researchers find acupuncture more effective than the selective acetylcholinesterase inhibitor donepezil hydrochloride for the treatment of cognitive impairment. Researchers from the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine determined that a particular method of acupuncture, Xing Nao Kai Qiao (Waking the Brain and Opening the Orifices), is more effective than standard medications in treating vascular cognitive impairment. Results were measured at 4 and 8 weeks after treatment. Patients receiving Xing Nao Kai Qiao acupuncture reported a 74.51% (4 weeks after treatment) and 91.11% (8 weeks after treatment) total treatment effective rate, whereas those in the control group reported 54.05% and 72.72% rates respectively. [1]

Multiple subjective and objective instruments were used to measure patient outcomes at several data points: prior to treatment (T0), 4 weeks (T1), and 8 weeks (T2) after completion of the treatment. First, the Montreal Cognitive Assessment (MoCA) Scale scores were recorded. MoCA is a widely used assessment tool for cognitive dysfunction. Second, the Ability of Daily Living (ADL) Scale scores were calculated. Third, the serum levels of insulin-like growth factor 1 (IGF-1) and visinin‐like protein‐1 (VILIP-1) were recorded. IGF-1 and VILIP-1 are two diagnostic and prognostic biomarkers of cognitive impairment and dementia. Fourth, the mRNA expression of IGF-1 and VILIP-1 were measured by real-time polymerase chain reaction (PCR).

There were no significant differences regarding MoCA and ADL scores at T0 in the two groups (p>0.05). After treatment, both groups saw increases in these scores at T1 and T2 (p<0.05), with significantly greater increases in the acupuncture group (p<0.05). The serum levels of IGF-1 and VILIP-1, as well as their mRNA expressions, decreased at T1 and T2. There was a statistically significant difference before and after treatment (p<0.05) and the acupuncture group significantly outperformed the drug control group at T1 and T2 (p<0.05).

 

Design
Researchers (Xu et al.) used the following study design. A total of 94 patients were treated and evaluated in this study. The patients were diagnosed with vascular cognitive impairment between April 2017 and June 2018. They were randomly divided into an acupuncture treatment group and a control group, with 56 and 38 patients in each group respectively. For the control group patients, donepezil hydrochloride was administered. The treatment group received acupuncture.

The statistical breakdown for each randomized group was as follows. The treatment group was comprised of 29 males and 27 females. The average age in the treatment group was 57.73 years. The average course of disease in the treatment group was 1.86 years. The control group was comprised of 20 males and 18 females. The average age in the control group was 56.97 years. The average course of disease in the control group was 1.83 years. There were no significant statistical differences in gender, age, and course of disease relevant to patient outcome measures for patients initially admitted to the study.

 

Treatment Procedure
For both groups, patients received general therapy according to China 2014 Guidelines for Secondary Prevention and Treatment of Ischemic Stroke and Transient Ischemic Attack, including the administration of 100 mg of aspirin tablets each dose per day and 20 mg of atorvastatin calcium tablets each dose per day. Aspirin was used to reduce blood clot formation and improve blood flow. Atorvastatin calcium can improve cholesterol levels and may prevent stroke. The drug control group patients were also given 5 mg of donepezil hydrochloride tablets each dose per day. The primary acupoints used for the treatment group included the following:

  • GV26 (Shuigou)
  • PC6 (Neiguan)
  • SP6 (Sanyinjiao)
  • EX-HN1 (Sishencong)
  • GB39 (Xuanzhong)
  • KI3 (Taixi)

Treatment commenced with patients in a supine position. After disinfection of the acupoint sites, a 0.25 mm × 40 mm disposable filiform needle was inserted into each acupoint with a high needle entry speed. For Shuigou, the needle was inserted obliquely towards the nasal septum, reaching a depth of 5–10 mm. After a deqi sensation was obtained, the needles were manually stimulated with the Zhong Que Zhuo (heavy sparrow pecking) manipulation technique. For Neiguan, the needle was inserted perpendicularly to a depth of 10–15 min. Once obtaining a deqi sensation, the needle was retained for 10 minutes. For Sanyinjiao, the needle was applied with the Bu (tonifying) technique after achieving a deqi sensation. The Bu technique should was applied until twitching of the lower limb was observed three times. The needles were retained for 20 minutes. For both groups, treatments were given 2 times per day (once at 9:00 am, and the other at 3:00 pm), 6 days per week, for a total of 8 weeks. After treatment completion for patients in both groups, the treatment efficacy for each patient was categorized into 1 of 4 tiers:

  • Recovery: MoCA scale scores increased by over 5 points; ADL scale scores over 7 points
  • Significantly effective: MoCA scale scores increased by 3 to 5 points; ADL scale scores increased by 3 to 6 points
  • Effective: MoCA scale scores increased by 1 to 3 points; the score of ADL scale increased by 0 to 3 points
  • Not effective: there was no significant change in the scores of MoCA and ADL before and after treatment.

 

Summary
The results indicate that acupuncture is more effective than the donepezil hydrochloride protocol as a monotherapy. Xu et al. conclude that acupuncture is safe and effective for the relief of vascular cognitive impairment.

 

Reference:
Xu GC, Zhang R. Clinical Study of Xingnao Kaiqiao Acupuncture in Treatment of Non- Dementia Vascular Cognitive Impairment [J]. Journal of Clinical Acupuncture and Moxibustion, 2019(08):8-12.

 

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