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Abstract

Background

Perioperative neurocognitive disorders (PND), including delirium and postoperative cognitive dysfunction (POCD), are common and debilitating complications in elderly patients undergoing total hip arthroplasty (THA). Electroacupuncture (EA) has shown potential in modulating neuroinflammation and oxidative stress, yet its preoperative efficacy in preventing cognitive decline remains unclear.

Methods

A single-center, randomized, patient- and assessor-blinded, sham-controlled trial was conducted with 150 patients aged 65 and older undergoing elective THA. Participants were assigned to receive EA pretreatment at acupoints Baihui (GV20) and Dazhui (GV14), or sham stimulation. The primary outcome was the change in Montreal Cognitive Assessment (MoCA) score from baseline to postoperative day 3 (POD3), a timepoint corresponding to the typical peak period of early postoperative cognitive decline. Early PND was predefined as a ≥ 2-point decline in MoCA score at POD3 compared with baseline. Secondary outcomes included delirium incidence, serum biomarkers (S100β, NSE, IL-1β, IL-6, TNF-α, cortisol), pain scores, opioid consumption, quality of recovery (QoR), and cognitive assessments at 1, 3, and 6 months after surgery.

Results

EA significantly attenuated cognitive decline (ΔMoCA −1.1 ± 2.0 vs −2.8 ± 2.5; p = 0.002) and reduced the incidence of early PND (≥2-point MoCA decline at POD3) (13.3% vs 28.0%; p = 0.028). EA also lowered postoperative biomarkers of neuronal injury and inflammation, including S100β, NSE, and pro-inflammatory cytokines, while improving pain control, reducing opioid consumption, and enhancing QoR. No serious adverse events occurred, and blinding integrity was maintained.

Conclusion

Preoperative EA at Baihui and Dazhui significantly improved early cognitive outcomes and reduced neuroinflammation in elderly patients undergoing THA. EA represents a feasible, non-pharmacological adjunct to perioperative care aimed at reducing early PND, with a favorable safety profile.

Keywords

electroacupuncture perioperative neurocognitive disorders postoperative cognitive dysfunction total hip arthroplasty neuroinflammation

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References

Aytaç

, et al. (2021). Comparison of postoperative cognitive decline using the mini-mental state examination and Montreal cognitive assessment after minor elective surgery in elderly. Cureus, 13(10), e18631. https://doi.org/10.7759/cureus.18631

Cai

Lee

J. H.

Yang

E. J.

(2019). Electroacupuncture attenuates cognition impairment via anti-neuroinflammation in an Alzheimer’s disease animal model. Journal of Neuroinflammation, 16(1), 264. https://doi.org/10.1186/s12974-019-1665-3

Evered

L. A.

Silbert

B. S.

(2018). Postoperative cognitive dysfunction and noncardiac surgery. Anesthesia & Analgesia, 127(2), 496–505. https://doi.org/10.1213/ANE.0000000000003514

Folstein

M. F.

Folstein

S. E.

McHugh

P. R.

(1975). “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198. https://doi.org/10.1016/0022-3956(75)90026-6

Han

J. S.

(2011). Acupuncture analgesia: Areas of consensus and controversy. Pain, 152(3 Suppl), S41–S48. https://doi.org/10.1016/j.pain.2010.10.012

Y. S.

, et al. (2024). Postoperative electroacupuncture boosts cognitive function recovery after laparotomy in mice. Biomolecules, 14(10), 1274. https://doi.org/10.3390/biom14101274

Huang

Wang

Zhang

Zhao

Wang

(2023). Electroacupuncture pretreatment protects against anesthesia/surgery-induced cognitive decline by activating CREB via the ERK/MAPK pathway in the hippocampal CA1 region in aged rats. Aging (Albany NY), 15(20), 11227–11243. https://doi.org/10.18632/aging.205124

Inouye

S. K.

van Dyck

C. H.

Alessi

C. A.

Balkin

Siegal

A. P.

Horwitz

R. I.

(1990). Clarifying confusion: The confusion assessment method. A new method for detection of delirium. Annals of Internal Medicine, 113(12), 941–948. https://doi.org/10.7326/0003-4819-113-12-941

Kong

L. M.

Wang

D. X.

(2022). Perioperative neurocognitive disorders: A narrative review focusing on diagnosis, prevention, and treatment. CNS Neuroscience & Therapeutics, 28(8), 1147–1167. https://doi.org/10.1111/cns.13873

10.

Kotekar

Shenkar

Nagaraj

(2018). Postoperative cognitive dysfunction - current preventive strategies. Clinical Interventions in Aging, 13, 2267–2273. https://doi.org/10.2147/CIA.S133896

11.

Liang

Zhang

Liang

(2025). The effects of different acupuncture modalities on postoperative cognitive function in elderly Chinese patients undergoing general anesthesia: A network meta-analysis. Frontiers in Neurology, 16, 1637566. https://doi.org/10.3389/fneur.2025.1637566

12.

Lin

Chen

Zhang

Chen

Zhou

(2020). The potential mechanism of postoperative cognitive dysfunction in older people. Experimental Gerontology, 130, 110791. https://doi.org/10.1016/j.exger.2019.110791

13.

Liu

Wang

(2022). Neuroinflammation in perioperative neurocognitive disorders: From bench to the bedside. CNS Neuroscience & Therapeutics, 28(4), 484–496. https://doi.org/10.1111/cns.13794

14.

Needham

M. J.

Webb

C. E.

Bryden

D. C.

(2017). Postoperative cognitive dysfunction and dementia: What we need to know and do. British Journal of Anaesthesia, 119(suppl\_1), i115–i125. https://doi.org/10.1093/bja/aex354

15.

Olotu

(2020). Postoperative neurocognitive disorders. Current Opinion in Anesthesiology, 33(1), 101–108. https://doi.org/10.1097/ACO.0000000000000812

16.

World Health Organization (2021). WHO Benchmarks for the Practice of Acupuncture. WHO Press.

17.

, et al. (2022). Electroacupuncture for the prevention of postoperative cognitive dysfunction among older adults undergoing hip and knee arthroplasty: A systematic review and meta-analysis of randomized controlled trials. Frontiers in Medicine, 8, 778474. https://doi.org/10.3389/fmed.2021.778474

18.

Park

J. Y.

Namgung

(2018). Electroacupuncture therapy in inflammation regulation: Current perspectives. Journal of Inflammation Research, 11, 227–237. https://doi.org/10.2147/JIR.S141198

19.

Park

White

Stevinson

Ernst

James

(2002). Validating a new non-penetrating sham acupuncture device: Two randomised controlled trials. Acupuncture in Medicine, 20(4), 168–174. https://doi.org/10.1136/aim.20.4.168

20.

Peng

Wei

Sun

Wang

Zhou

(2024). Electroacupuncture and transcutaneous electrical acupoint stimulation for perioperative neurocognitive disorder in older patients undergoing cardiac surgery: Protocol for systematic review and meta-analysis. JMIR Research Protocols, 13, e55996. https://doi.org/10.2196/55996

21.

Rong

Ding

Z. C.

H. D.

Yao

S. Y.

Zhou

Z. K.

(2021). Risk factors of postoperative delirium in the knee and hip replacement patients: A systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 16(1), 76. https://doi.org/10.1186/s13018-020-02127-1

22.

Sadeghirad

, et al. (2023). Perioperative factors associated with postoperative delirium in patients undergoing noncardiac surgery: An individual patient data meta-analysis. JAMA Network Open, 6(10), e2337239. https://doi.org/10.1001/jamanetworkopen.2023.37239

23.

Schulz

K. F.

Altman

D. G.

Moher

Group

(2010). CONSORT 2010 statement: Updated guidelines for reporting parallel group randomized trials. Annals of Internal Medicine, 152(11), 726–732. https://doi.org/10.7326/0003-4819-152-11-201006010-00232

24.

Shen

Zhang

Gao

(2024). Meta-analysis with trial sequential analysis investigating the impact of adjunctive electroacupuncture therapy on vascular mild cognitive impairment. Translational Psychiatry, 14(1), 349. https://doi.org/10.1038/s41398-024-03052-1

25.

Stark

P. A.

Myles

P. S.

Burke

J. A.

(2013). Development and psychometric evaluation of a postoperative quality of recovery score: The QoR-15. Anesthesiology, 118(6), 1332–1340. https://doi.org/10.1097/ALN.0b013e318289b84b

26.

Steinmetz

Christensen

K. B.

Lund

Lohse

Rasmussen

L. S.

Group

(2009). Long-term consequences of postoperative cognitive dysfunction. Anesthesiology, 110(3), 548–555. https://doi.org/10.1097/ALN.0b013e318195b569

27.

Terrando

Monaco

Foxwell

B. M.

Feldmann

Maze

(2010). Tumor necrosis factor-alpha triggers a cytokine cascade yielding postoperative cognitive decline. Proceedings of the National Academy of Sciences of the United States of America. S. A, 107(47), 20518–20522. https://doi.org/10.1073/pnas.1014557107

28.

, et al. (2024). Comparative effectiveness of non-pharmacological therapies for postoperative cognitive dysfunction: Protocol for a systematic review and network meta-analysis. PLoS One, 19(12), e0309605. https://doi.org/10.1371/journal.pone.0309605

29.

Xiao

Q. X.

Liu

Deng

Gao

Z. W.

Zhang

(2020). Postoperative cognitive dysfunction in elderly patients undergoing hip arthroplasty. Psychogeriatrics: The Official Journal of the Japanese Psychogeriatric Society, 20(4), 501–509. https://doi.org/10.1111/psyg.12516

30.

Zheng

Huang

Yan

(2023). Effects of electroacupuncture at Baihui and Dazhui on perioperative neurocognitive impairment and S100-β, LC3-II, Beclin-1 in patients with colon cancer. American Journal of Translational Research, 15(6), 4237–4245.

31.

Zhang

Lao

Ren

Berman

B. M.

(2014). Mechanisms of acupuncture-electroacupuncture on persistent pain. Anesthesiology, 120(2), 482–503. https://doi.org/10.1097/ALN.0000000000000101

32.

Zhang

Jiao

Wen

Zheng

(2025). Electroacupuncture regulates ferroptosis to improve postoperative cognitive dysfunction in mice through mediating GRX1/GSK-3β/Nrf2 axis. Brain Research Bulletin, 222, 111234. https://doi.org/10.1016/j.brainresbull.2025.111234

33.

Zhang

, Cairen, Z., Shi, L, et al. (2023). Acupuncture-related techniques for postoperative cognitive complications: A systemic review and meta-analysis. Perioperative Medicine, 12(1), 14. https://doi.org/10.1186/s13741-023-00303-5

34.

Zhang

, Chen, L., Guo, Y, et al. (2023). The neuroprotective and neural circuit mechanisms of acupoint stimulation for cognitive impairment. Chinese Medicine, 18(1), 8. https://doi.org/10.1186/s13020-023-00707-x

35.

Zhao

Zou

(2024). Effects of electroacupuncture on postoperative cognitive dysfunction and its underlying mechanisms: A literature review of rodent studies. Frontiers in Aging Neuroscience, 16, 1384075. https://doi.org/10.3389/fnagi.2024.1384075

36.

Zhao

Z. Q.

(2008). Neural mechanism underlying acupuncture analgesia. Progress in Neurobiology, 85(4), 355–375. https://doi.org/10.1016/j.pneurobio.2008.05.004

Effect of Electroacupuncture Prestimulation on Early Cognitive Function After Hip Replacement in Elderly Patients and Its Mechanism

Abstract

Background

Methods

Results

Conclusion

Keywords

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References