Comparisons of Acupuncture Therapies combining Conventional Treatment in the Management of Vascular Cognitive Impairment: A systematic review and network meta-analysis

Yuan-Ling Liao¹Chang Ti Lee^1,2LI JEN SU^2,3Pei Shan Hsu¹Yi-Ying Shen¹Adam Tsou¹Chou-Chin Lan^1,4I-Shiang Tzeng¹Guan-Ting Liu¹Po-Chun Hsieh, MD, PhD^1,5*

• ¹Taipei Tzu Chi Hospital, New Taipei City, Taiwan
• ²Department of Biomedical Sciences and Engineering, National Central University, Jhongli, Taiwan
• ³nstitute of Systems Biology and Bioinformatics, National Central University, Jhongli, Taiwan
• ⁴Tzu Chi University, Hualien City, Taiwan
• ⁵School of Chinese Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

Vascular cognitive impairment (VCI) is the second most frequent form of cognitive disorder. It is mainly caused by a diseased cerebral vasculature and affects patients' cognition and activities of daily living (ADL). Previous studies have demonstrated that acupuncture therapy is a promising complementary treatment that significantly improves cognitive status and ADL in VCI patients. This study aimed to investigate the effects of different types of acupuncture therapies and conventional treatments on cognitive status and ADL in VCI patients to provide evidence-based clinical recommendations.We searched seven electronic databases for randomized controlled trials comparing acupuncture therapies (including manual acupuncture (MA), scalp acupuncture (SA), electroacupuncture (EA), and auricular acupuncture (AA)) with conventional treatment (pharmacotherapy [P], cognitive rehabilitation [CR]) or standard care (SC) in patients with VCI. The primary outcome was cognitive improvement, while secondary outcomes included improvement in ADL and the risk of severe adverse effects. A frequentist random-effects network meta-analysis was performed under a consistency model. Study quality was assessed using the RoB 2.0 tool. Inconsistency was examined via nodesplitting. Subgroup analysis, meta-regression, and sensitivity analysis were conducted to explore heterogeneity and assess robustness. Publication bias was evaluated using funnel plots and Egger's test.Through stepwise exclusion of studies contributing to publication bias and inconsistency, a robust bias-adjusted network meta-analysis dataset was established. The results showed that among all interventions, SA+P+SC demonstrated the greatest efficacy in improving cognitive status compared to SC (SMD: 2.04; 95% CI: 1.21-2.86) with substantial heterogeneity (I² = 71.0%), no significant inconsistency, and relative low publication bias (p = 0.7020).Acupuncture, particularly SA combined with P and SC, appears to be a safe and effective adjunctive treatment for patients with VCI. Future studies are warranted to establish VCI-specific MCID thresholds and to validate these findings through large-scale, high-quality RCTs.