How Can Acupuncture Be Used in Treating Dementia?
Received: March 2, 2018 | Accepted: April 11, 2018 | Published: April 23, 2018
OBM Integrative and Complementary Medicine 2018, Volume 3, Issue 2 doi:10.21926/obm.icm.1802005
Academic Editor: James D. Adams
Recommended citation: Cheng FK. How Can Acupuncture Be Used in Treating Dementia? OBM Integrative and Complementary Medicine 2018;3(2):005; doi:10.21926/obm.icm.1802005.
© 2018 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.
Statistical data warn that 7.7 million new cases each year worldwide have been added on top of the existing 47.5 million people with dementia . Dementia is a neuro-degenerative syndrome  caused by a reduction in the number of neurons, resulting in a deterioration of neuronal structure and functions, which incurs a progressive or chronic decline in cognition, thinking, memory, comprehension, language, learning, judgement, behaviour, emotion, and self-care . These impairments demand about 1% of the global gross domestic product  to serve patients and their families, and deplete the workforce in cases where young-onset dementia begins before 65 years old .
The aetiological mechanism of dementia has not yet been well-identified , but this disease stems from a variety of heterogeneous factors , yielding various types such as senile dementia (Alzheimer’s disease) , vascular dementia , Lewy bodies dementia, frontotemporal dementia, and primary progressive aphasia . Additionally, in 12-20% of patients [11,12], the disease is induced by reversible causes ; for example, depression induced cognitive impairment, surgical brain lesions, tumours and chronic subdural hematomas, structural brain abnormalities, metabolic disorders, alcohol and medication related dementia, toxicants, infection, and nutritional deficiencies , which are all likely treatable.
Apart from formal medical treatments for dementia, including medication, behavioural-oriented therapies, and psychosocial interventions [15,16,17], complementary and alternative medicine has been adopted with positive outcomes , for instance, aerobic exercise , art therapy , creative therapy , dancing therapy , music therapy , gardening , and Ginkgo biloba , together with traditional Chinese methods .
Many ancient Chinese medicinal records , such as the Emperor’s Inner Canon  (also known as Huangdi Neijing or the Inner Canon of Huangdi), documented the effectiveness of acupuncture on syndromes or symptoms that are similar to dementia. Acupuncture is a Chinese medical method that has been practised for over 3,000 years. Its objective is to restore the flow of qi (energy) within the body  through the stimulation of nerve endings, which consequently enhances brain function , attaining healthy, balanced life energy . It normally uses 5-15 needles penetrating at specific points (namely, acupoints) from 365 acupoints located along 14 meridians  throughout the body.
Acupuncture has become an option for treating Parkinson’s disease , Alzheimer’s disease [34,35] and dementia [36,37], as supported by Chinese projects since the 1980s . In particular, its effects on vascular dementia have shown improvements in memory, cerebral ischemia, hippocampus function, and synaptic plasticity, in the regulation of vasoactive substances and blood flow in the brain, in the prevention of excessive free radicals, the facilitation of angiogenesis, the inhibition of neuronal apoptosis, and in the modulation of neurotransmitter production, as well as increases in glucose metabolism [39,40,41,42,43,44], and the amelioration of cognitive impairment : albeit Lee and colleagues  are hesitant regarding these outcomes.
Diverse acupuncture methods have been utilised for dementia, such as body acupuncture, scalp acupuncture, ophthalmic acupuncture, tongue acupuncture, and acupoint injection [47,48,49,50]. Moreover, acupuncture may combine with other approaches [51,52,53]; for example, Chinese herbs , pharmaceutical drugs , and moxibustion . Benefiting from modern technology, it has also developed further into different modes, including electro-acupuncture, and laser acupuncture.
This narrative review analyses how acupuncture can alleviate dementia symptoms, through either acupuncture alone or through combined therapies. The findings of the reviewed clinical research potentially supply alternatives to medical practitioners and patients for preventive, curative, and rehabilitative purposes.
2. Research Methods
This review adopted 27 major digital databases in ProQuest; for instance, Biological Sciences, British Nursing Index, MEDLINE, ProQuest Medical Library, PsycARTICLES, and PsycINFO. The keywords “acupuncture”, “dementia” and “Alzheimer’s disease” were input; 114 studies were listed. Additionally, two significant Chinese databases – China National Knowledge Infrastructure (CNKI) and Taiwan Electronic Periodical Services (TEPS) – were employed, in which the keywords included “針灸” and “失智症OR癡呆症OR腦退化症OR認知障礙症OR阿茲海默症OR阿爾茨海默氏症”, resulting in 451 potential projects.
Figure 1 Selection process
The retrieved clinical human-based research which was published in peer-reviewed scholarly journals prior to 2018 was selected. Duplicated works, non-resultant trials, literature reviews, book reviews, dissertations, letters to the editor, and commentaries were excluded. According to the eligibility criteria, 44 projects (n=12 in English, n=32 in Chinese) were reviewed (Figure 1), which included 3078 participants who were 45-100 years old in Austria (n=1), China (n=40), Hong Kong (n=1), Japan (n=1) and the USA (n=1), and were carried out from 1998 to 2017.
3. Results and Discussion
This narrative review (refer to Table 1) delves into the effects of acupuncture on dementia from the perspectives of being used singly, or in combination with other therapies, impacting neurological effects and reducing dementia-induced mental problems. Also, comparison studies analyse the effectiveness of different combined approaches. The research outcomes unveil decreases in dementia symptoms following both acupuncture used alone and combined methods; however, the latter yields a higher effectiveness rate.
3.1 Acupuncture Used Alone
This narrative review investigates the effects of using acupuncture alone on neurological, cognitive, and mental improvements [57,58]. It also exhibits comparison studies which have compared the effectiveness of acupuncture and medication, as well as different acupuncture techniques.
Neurological changes. Acupuncture has remarkable benefits for cognition in dementia rehabilitation , likely due to the following discoveries. When stimulating points at Taichong (LR3) and Hegu (LI4), it increases connectivity in most of the hippocampus-related regions in patients affected by Alzheimer’s disease, particularly the connection between the right middle front lobe and the left hippocampus . This path activates the cognitive-associated regions , especially those that contribute to early dementia .
Randomly assigned to two groups , ten participants with vascular dementia and stroke experience each underwent 20-minute sessions but at different acupoints for these two groups. Assessments were carried out using positron emission tomography (PET), which indicated cerebral metabolism in the lentiform nucleus of the affected hemisphere, and the temporal lobe of the non-affected hemisphere. One case study reported that a 77-year-old woman with cerebral-vascular dementia intensified both cerebral oxygen saturation and cerebral blood flow velocity after seven 10-minute acupuncture sessions (by needle and laser), improving cognitive function, motor speech function, short memory, sleeping, and headaches , along with quality of life .
Lowering cognitive symptoms. Shi  evaluated the effects of acupuncture among 36 participants with vascular dementia who joined an intervention, reporting enhancements in cognition, memory, and language 14 days after treatment, and in visual and spatial skills 28 days after treatment. However, there was a lack of intervention details. Another research programme with 54 patients received 30 13-minute sessions for scalp acupuncture, resulting in improved cognitive function, including gains in orientation, calculation, and behaviour , which was supported by a Japanese project  and a randomised controlled trial  showing significant improvements in cognitive ability and daily life activities.
Weakening dementia-related mental problems. Apart from neuro-refinement, acupuncture can also treat dementia-led mental illnesses through the amelioration of outside symptoms: such as sleep problems, which worsen dementia symptoms . In a within-subjects designed project, 19 participants were observed in the control stage for six weeks, after which they took part in 12 30-minute sessions for another six weeks . Despite the absence of significant indicators of sleep efficiency on the pre- and pro-tests, improvements in resting and sleeping times were apparent after treatment.
Depression is common in the dementia population , which in turn increases risks for dementia as well . Lombardo and colleagues  investigated 11 patients who were given three 30-minute sessions in the first week and 2-3 sessions per week in weeks 7-10. Although they reported slight amelioration in depression and anxiety, they experienced significant enhancements in energy.
Comparison studies. Zhu and colleagues  randomly allocated 30 patients to receive 30-minute daily acupuncture treatments for 8 weeks, and another 30 patients to take 30mg of nimodipine, thrice a day for 8 weeks. Improved scores were reported in the Mini-Mental State Examination and Montreal Cognitive Assessment, and lower levels of high sensitivity C-reactive protein (hs-CRP) and interleuk-6 (IL-6) levels were apparent in both groups. Moreover, better indicators in the Syndrome Differentiation Scale of Vascular Dementia and in the above tests were exhibited in the acupuncture group than in the medication group, implying better enhancements in cognition. This was further supported by Liu and team , Jia , Tan and colleagues , and Zheng and Zhang . Another similar study compared acupuncture and piracetam, showing more positive signals on P300 (an endogenous potential) in the acupuncture group, implying better improvements in their memory, cognition, and emotions . Zhu , as a supplement to his research, reported that 95% of patients in the acupuncture group revealed improvements in cognition, compared to 75% in the piracetam group.
Aside from the basic one-needle-one-acupoint technique, point-through-point acupuncture has also been utilised. This special technique reaches more than one acupoint by means of a single needle. Thirty patients were randomly distributed to the basic technique group and another 30 to the point-through-point group. They underwent 30-minute daily sessions over a period of 30 days. Results showed that 83.3% of patients in the latter group yielded improvements in their dementia symptoms, compared to 60% in the former .
3.2 Combined Methods
In addition to the confident results from acupuncture treatments used alone to treat dementia, researchers have examined combined interventions that present even greater effectiveness .
With neuro-developmental therapy. One project assigned 39 patients to a Bobath therapy group, and another 39 to an experimental group that combined acupuncture and the Bobath technique . Bobath therapy is a multidisciplinary neuro-developmental approach for neurological rehabilitation to improve motor control, body alignment, and movement coordination. 91.4% of patients in the experimental group indicated improvements in neurological impairment, cognitive function, and daily activities, compared to 85.3% in the Bobath therapy group.
With medications. Studies comparing the combination of acupuncture and drugs reveal positive signs as well. One study spelled out improvements in cognition, memory, and language, following 14 days of treatment using acupuncture and medication, and in visual spatial skills after 28 days of treatment . This was supported by other research . However, no information about the medication was provided in these projects.
Liu and team  randomly assigned 168 patients to two groups equally for a 56-day examination period. The control group took 5mg of donepezil hydrochloride once a day; the treatment group took the same dose along with acupuncture. The results presented more noticeable improvements in cognitive functions in the latter than in the former. In another project, both the experiment and control groups were offered identical therapy: acupuncture and medication (antiplatelet agents, antihypertensive, diuretics and nimodipine) , and the experimental group was given additional acupuncture treatments at different acupoints. They improved in cognitive function, memory, and self-care, but the effectiveness rates differed: 80% for the former, and 46.7% for the latter. Therapy combining acupuncture and piracetam tablets produced similar outcomes [89,90].
Three equal groups were randomly distributed : Group 1 was given 30 minutes of acupuncture and moxibustion; Group 2 was given 20mg huperzine A tablets, thrice per day for 30 days; and Group 3 was assigned acupuncture, moxibustion, and tablets. Improvements were reported related to cognitive functions: 83.3% in Group 1, 66.7% in Group 2, and 93.3% in Group 3, reflecting the effectiveness of combined Chinese and Western methods.
Comparison has also been applied to Chinese medicine with encouraging results in recent studies; for instance, Guo , He and colleagues , Huang , Li and members , Ni , Niu , and Yang and team . One project with 68 participants randomly allocated between an acupuncture group and an acupuncture with Six Flavour Rehmanni (Chinese medicine) group . Improvements were apparent in 88.2% of the patients in the combined group, but only 67.6% in the single treatment group. Nevertheless, participants underwent differing treatment periods: 30 days (n=24), 40 days (n=22), 50 days (n=12), and 60 days (n=10). Further analyses became difficult owing to insufficient details on research design and results.
Looking into the effects of different combinations, 60 patients were randomly, equally assigned to an acupuncture with Chinese medicine group, an acupuncture with Western drugs group (folic acid 10mg, vitamin B6 30mg, huperzone A tablet 0.1mg, twice a day), and a non-treatment group . According to the three measurements at pre-treatment, and at the 3rd and 6th months, the acupuncture with Chinese medicine group exhibited better outcomes than the acupuncture with Western drugs, and no changes were presented in the non-treatment group.
Moreover, Wu and Guo  recruited 56 patients who undertook a daily programme, including acupuncture, Chinese medicine, and drugs (donepezil and nicergoline). The findings showed 83% success rate and low side effect rate (10%). They also indicated significant improvements in self care and quality of life. Other research substantiated these outcomes [101,102,103].
Table 1 Analysis of the 44 reviewed studies
Recommendations are discussed here regarding research and practical implications. Despite the results in this review which reported that dementia symptoms are mitigated by acupuncture or combined treatments, the sample sizes were usually less than 80 participants (n=29 projects). This lowers data reliability and negatively affects the representation and generalisation of the research outcomes. A larger sample size is suggested to gather robust data .
The effects of acupuncture on dementia have been demonstrated through this review. However, there is an absence of follow-up investigations , which causes difficulties in judging effect duration. Follow-up or longitudinal studies are therefore proposed to inquire into whether the effects of acupuncture are valid over the long-term.
Although there are randomised controlled trials in the reviewed projects (n=29), most of them did not detail their randomisation process or research design. It is justifiable to carry out well-designed randomised examinations to produce scientific and reliable data.
In light of Chinese medicinal theories, treatments are designed to meet individual needs. Thus, there is no protocol for acupuncture therapy  with different numbers of acupoints. If more elaboration on patterns of acupoint penetration had been presented, researchers could have studied in a more systematic manner.
Chinese medicine aims to strengthen life energy, focusing on prevention. Further study is therefore recommended on how acupuncture can delay the onset of dementia , which would optimise the advantages of acupuncture from the preventive perspective.
This narrative review analyses 44 clinical, human-based research projects conducted in Asia Pacific and North America with 3078 participants, aged 45-100. It offers an overview of how acupuncture can contribute to dementia by using acupuncture either singly or combined with other approaches. Acupuncture is comparatively safe and cost-effective when treatment is performed by a qualified, trained practitioner. According to this analysis, acupuncture is potentially effective in improving the cognition, memory, language, behaviour, emotions, and self-care of patients with dementia symptoms. It also proves that its combination with medications or other therapies can maximise these consequences. In short, acupuncture is suggested for preventive, remedial, and rehabilitative purposes; however, it does need further well-designed scientific research with more reliable data sets.
The author is responsible for the entire process of writing up, revising, and approving the final version of this manuscript.
There is no conflict of interest to declare with respect to the present manuscript submitted for publication.
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