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Abstract

Background

Alzheimer's disease (AD) and mild cognitive impairment (MCI) cause progressive cognitive decline, with Western medicine only alleviating symptoms at present. Acupuncture shows potential for these disorders, but existing studies have inconsistent results.

Objective

To examine the effect of acupuncture on overall cognitive function in patients with AD and MCI via meta-analysis.

Method

Literature from six databases on acupuncture, AD, and MCI was searched. Meta-analyses and moderator analyses were performed using Comprehensive Meta Analysis V3.0.

Results

52 randomized controlled trials (RCTs) involving 3362 AD/MCI patients were included. Results showed that acupuncture alone outperformed blank or placebos (SMD=1.09, 95% CI = [0.60, 1.58], p < 0.001, I² = 91.39%). In addition, acupuncture alone (SMD = 0.45, 95% CI = [0.22, 0.67], p < 0.001, I² = 69.38%) and combined with Western medicine (SMD = 1.18, 95% CI = [0.92, 1.44], p < 0.001, I² = 90.73%) were superior to Western medicine alone. Moderator analysis revealed significant effect of type of patients, showing larger effect in AD than MCI in acupuncture combined with Western medicine (Q = 10.20, p = 0.001). Regarding types of acupuncture, manual acupuncture (MA) and electroacupuncture (EA) showed no significant difference between them (alone: Q = 0.38, p = 0.536; combined with Western medicine: Q = 0.57, p = 0.449) and both outperformed Western medicine alone.

Conclusions

Acupuncture could improve overall cognitive function in AD and MCI, with similar effects between MA and EA. Due to the heterogeneity and variable methodological quality of the studies included, our results must be interpreted with caution. Still, these results suggest acupuncture may be an adjuvant to Western medicine for eligible patients and a potential alternative for short-term cognitive improvement when Western medicine is contraindicated.

Keywords

acupuncture Alzheimer's disease meta-analysis mild cognitive impairment randomized controlled trials

Introduction

Alzheimer's disease (AD) is a neurodegenerative disorder characterized by gradual cognitive decline and the most common cause of dementia.¹ Mild cognitive impairment (MCI) refers to cognitive function below normal aging levels (not meeting dementia diagnostic criteria) and an intermediate state between normal aging and dementia.¹ A Chinese national cross-sectional study reported a 6.04% dementia incidence and 15.54% MCI prevalence in adults over 60 years²; a Mayo Clinic aging study found 10.0% dementia and 16.0% MCI prevalence in those aged 70–89 years.³ AD imposes a heavy burden on patients, caregivers, and healthcare systems, with economic costs rising markedly as the disease progresses.⁴ While early diagnosis is critical for AD management, no effective drugs to halt or reverse AD progression have been developed to date, even for early-stage cases.⁵ Consequently, non-pharmacological interventions for preventing cognitive decline and dementia have become a key clinical research hotspot.^6–9

Among these non-pharmacological interventions, acupuncture is a core traditional Chinese medicine therapy with a millennia-long history, well established for its role in disease treatment and health promotion.^10–14 It aids post-stroke hemiplegia rehabilitation,¹¹ improves post-stroke depression,¹² alleviates rheumatic diseases symptoms¹³ and mitigates chronic fatigue syndrome fatigue.¹⁴ Gaining global attention in recent decades,^15–18 acupuncture has emerged as an effective adjuvant therapy for MCI and AD, with clinical evidence confirming improved cognitive function and quality of life in patients.^19–21 A review of animal studies has further delineated multi-faceted neuroprotective mechanisms of acupuncture in AD. These include acupuncture-induced regulation of abnormal brain protein expression, acupuncture-mediated modulation of microglial physiology and pathology, acupuncture-based regulation of mitophagy and epigenetic modifications, acupuncture-enhanced synaptic plasticity, and acupuncture-driven mitigation of oxidative stress coupled with energy metabolism. Together, these mechanisms underpin acupuncture's beneficial effects in ameliorating cognitive symptoms in affected individuals.²²

Unlike pharmacological therapies, acupuncture is a complex intervention influenced by multiple factors. Rooted in traditional Chinese medicine's “syndrome differentiation and treatment” principle, core variables influencing acupuncture efficacy include treatment type (e.g., acupuncture alone or combination with drugs), techniques (e.g., electroacupuncture (EA), manual acupuncture (MA), and manipulations like lifting-thrusting, twisting, rotating), acupoint selection (e.g., Baihui, Fengchi, Sishencong, Taixi, Dazhui, Zusanli, Yongquan, etc.), and their combinations.²³ These factors potential challenges for formulating standardized acupuncture protocols and evaluating therapeutic effects.

This study aimed to perform a meta-analysis of randomized controlled trials (RCTs) on acupuncture for AD and MCI, evaluating its effect on the cognitive function of patients with AD spectrum disorders. Building on preliminary evidence confirming acupuncture's efficacy for cognitive impairment, while the influence of specific intervention parameters remains unclear, this meta-analysis further investigates how stimulation types (MA, EA) and different stages (MCI, AD) affect outcomes. The goal is to inform the development of auxiliary acupuncture protocols for AD spectrum disorders and provide a theoretical foundation for the clinical application of traditional Chinese medicine-based acupuncture.

Methods

This study was conducted in accordance with the PRISMA guidelines (https://www.prisma-statement.org). Literature searches were performed across multiple databases: Web of Science, PubMed, Cochrane Library, Embase, Wanfang Medical Network, and China National Knowledge Infrastructure (CNKI) from their inception to May 01, 2025. Combined MeSH Terms (e.g., “Alzheimer Disease”, “Cognition”, “Cognitive Dysfunction”, “Acupuncture”, “Acupuncture Therapy”, and “Electroacupuncture”) and Free Terms (e.g., “Alzheimer's Diseases”, “Cognitions”, “Cognitive Function”, “Mild Cognitive Impairment”, “Acupuncture Treatment”, and other relevant free terms) were used. The Chinese versions of the above keywords were used for Wanfang Medical Network and CNKI. The detailed search strategies in English and Chinese databases were illustrated in Supplemental Material S1. Two authors conducted the searches independently, cross-verified results, and resolved discrepancies through a third author before initiating literature screening. The study was registered on PROSPERO (CRD420251045566).

Inclusion and exclusion criteria

Literature screening followed the PICOS framework, with specific inclusion criteria and exclusion as below:

Inclusion criteria

Study Population: Patients (either with AD or MCI) were diagnosed by clinical physicians and met the following criteria:

For AD: general classification standards (the Chinese Classification and Diagnostic Criteria for Mental Disorders (CCMD-3),²⁴ International Classification of Diseases (ICD-10),²⁵ Diagnostic and Statistical Manual of Mental Disorders (DSM-IV/5)²⁶), or AD-specific international criteria (National Institute on Aging-Alzheimer's Association (NIA-AA),²⁷ National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer Disease and Related Disorders Association (NINCDS-ADRDA),²⁸ International Working Group (IWG-2),²⁹ relevant AD sections of the 2018 Chinese Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Impairment^30,31), or traditional Chinese medicine diagnostic standards for AD^32–40;

For MCI: MCI-specific criteria (Petersen's criteria,⁴¹ the Jak/Bondi 2014 criteria,⁴² guidelines for MCI clinical research,⁴³ relevant MCI sections of the 2018 Chinese Guidelines⁴⁴), or some traditional Chinese medicine diagnostic standards for MCI^32,33,35,45;

2. Intervention: Experimental group: acupuncture alone or in combination with one of the following Western medicines (donepezil, rivastigmine, galantamine, memantine, or huperzine A). Control group: placebos (placebos needles, stimulation at non-acupoints, oral placebos), blank control (no treatment), or one of the aforementioned Western medicine alone;

3. Outcome measures: At least one scale assessing overall cognitive function: Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog), and Hasegawa Dementia Scale (HDS);

4. Study Design: RCTs.

Exclusion criteria

Animal experiments;

Ineligible participants: patients with cognitive impairments caused by non-AD/MCI diseases (e.g., traumatic brain injury, Parkinson's disease, vascular dementia, frontotemporal dementia), or unrelated diseases (e.g., fibromyalgia, autism, cancer);

Methodologically/typologically invalid studies: non-RCTs, reviews, retracted articles, literature lacking results (e.g., editorials, conference abstracts, trial protocols), or non-full-text articles, or non-Chinese/English literature;

Non-compliant interventions (e.g., point injection, laser acupuncture, or tap-pricking);

Outcome measures do not include any of the four scales (MMSE, MoCA, ADAS-cog, HDS).

Study selection

The literature screening process is illustrated in Figure 1. Retrieved studies were imported into the NoteExpress V4.1, where duplicates were removed using the software's built-in duplicate-checking function. Subsequently, YFC and SGZ independently screened titles/ abstracts against the inclusion/ exclusion criteria to excluded irrelevant studies, followed by full-texts review of the retained articles. After independent screening, the two authors cross-validated their results; any discrepancies were resolved through discussion with the corresponding author (PPL) to reach consensus.

Figure 1.

Literature screening process.

Data extraction

Data extraction covered first author, language, study characteristics (publication year, patient type, diagnostic criteria), participant characteristics (sample size, mean age, disease duration), intervention details for both the experimental and control groups, and the outcomes measures. If data were incomplete, we attempted to contact the original study's corresponding author to obtain complete information. Two authors independently extracted data using a predefined form, with any discrepancies resolved through discussion with the corresponding author.

Study risk of bias assessment

Study quality assessment followed the Cochrane Handbook for Systematic Reviews of Interventions (http://handbook.cochrane.org/), covering seven domains including random sequences generation, allocation concealment, blinding of participants and personnel, outcome assessment blinding, completeness of outcome data, selective reporting, and other biases. Risk of bias was categorized as “low risk of bias”, “unclear risk of bias”, or “high risk of bias”. Two authors independently evaluated study quality to ensure the rigor and accuracy of bias assessment; discrepancies were resolved via discussion between the two authors or by a third author. Bias analysis results were visualized using the Cochrane Risk of Bias Tool in Review Manager 5.3 (https://training.cochrane.org/online-learning/core-software/revman).

Statistical analysis

For continuous variables, effect size were calculated using the means and standard deviation, quantified as standard mean difference (SMD) with a 95% confidence interval (CI). Meta-analysis was performed in Comprehensive Meta-Analysis version 3.0 (https://zh.meta-analysis.com) with a significance level of p < 0.05.

Heterogeneity was assessed via the Cochran Q test and I² statistic, with a random-effects model was used in cases of high heterogeneity (I² ≥ 50%, p value of Q test < 0.05), and a fixed-effects model used when heterogeneity was low (I² < 50%, p value of Q test ≥ 0.05). Publication bias was evaluated using Begg's test, Egger's test, and funnel plots, with the trim-and-fill procedure for correction. The fail-safe N (additional zero-effect studies needed to negate significant result) was calculated to assess publication bias. With k as the number of included studies, a fail-safe N > 5k + 10 (a threshold requiring far more additional zero-effect studies to nullify significance than k) indicated the pooled effect size was robust to publication bias.

Sensitivity analysis was performed in Stata 15 by sequentially excluding individual studies to detect sources of heterogeneity. Studies were identified as a potential source requiring further analysis if, upon their exclusion, the 95%CI significantly deviated from the original range or if the I² statistic showed a significant decrease. To further explore heterogeneity, predefined moderator (subgroup) analysis was conducted, with classification criteria including patient type (AD vs. MCI) and acupuncture method (MA vs. EA).

Results

Study screening

A total of 25,711 articles were identified from database searches. Following literature screening (Figure 1), 52 articles^46–97 were included, categorized into three comparisons including acupuncture vs. blank or placebos (n = 9), acupuncture vs. Western medicine (n = 15), and acupuncture combined with Western medicine vs. Western medicine (n = 28). The characteristics of the included studies are presented in Table 1, encompassing 3362 participants (2498 with AD; 864 with MCI).

Table 1.

Basic characteristics of the included studies.

First author	Language	Year	Types of patients	Diagnostic criteria	Sample size of treatment group	Sample size of control group	Age (treatment/control)	Duration of disease (years)	Intervention		Outcome	Results
First author	Language	Year	Types of patients	Diagnostic criteria	Sample size of treatment group	Sample size of control group	Age (treatment/control)	Duration of disease (years)	T	C
Yuan⁹³	Chinese	2021	MCI	1	20	20	64.05 ± 1.27/63.15 ± 1.29	_	MA	In the non-acupoint group, the non-acupoints were selected next to the acupoints in the acupuncture group	MMSE, MoCA, ADAS-Cog	MMSE: T ＞ C MoCA: T ＞ C ADAS-Cog: T ＞ C
Hu et al.⁵⁷	Chinese	2010	AD	2 + 3	40	40	69.38 ± 6.539/68.08 ± 6.904	_	MA	No treatment	MMSE	T ＞ C
Feng et al.⁵³	Chinese	2009	MCI	7	50	49	60.2 ± 3.1/62.5 ± 3.6	_	MA	Placebo needle (special acupuncture needle, Non-acupuncture needle)	MMSE, ADAS-Cog	MMSE: T ＞ C ADAS-Cog: T ＞ C
Chen et al.⁵⁰	Chinese	2019	MCI	4 + 5	32	32	71 ± 5/71 ± 5	5.87 ± 6.67/6.38 ± 4.87	MA	The control group was treated with non-transdermal sham acupuncture, and the acupoints were the same as those in the observation group	MMSE, MoCA	MMSE: T = C MoCA: T ＞ C
Tan et al.⁷⁵	English	2017	MCI	6	16	16	65.88 ± 4.66/64.56 ± 5.25	_	MA	sham acupoint	MMSE, MoCA, ADAS-Cog	MMSE: T ＞ C MoCA: T ＞ C ADAS-Cog: T ＞ C
Li et al.⁶⁵	English	2020	MCI	8	14	14	_	—	MA	No treatment	MMSE, MoCA	MMSE: T ＞ C MoCA: T = C
Xu et al.⁸⁸	Chinese	2023	AD	2	40	40	67.78 ± 5.00/68.12 ± 4.41	2.01 ± 0.76/2.26 ± 0.71	MA	Oral placebo	MMSE	T ＞ C
Lin et al.⁶⁷	Chinese	2014	AD	2 + 3	18	18	73.44 ± 3.37/74.21 ± 2.68	1.40 ± 0.62/1.29 ± 0.81	EA	Donepezil	MMSE, ADAS-Cog	MMSE: T = C ADAS-Cog: T = C
Liu et al.⁶⁸	Chinese	2009	MCI	2 + 6	9	8	73 ± 8/77 ± 6	2.50 ± 0.93/2.33 ± 0.66	EA	Donepezil	MMSE	T ＞ C
Sun et al.⁷³	Chinese	2009	MCI	2	21	20	65.7 ± 4.2/64.9 ± 5.2	1.11 ± 0.63/1.17 ± 0.51	MA	Donepezil	MoCA	T = C
Jiang et al.⁵⁹	Chinese	2004	AD	2 + 3	24	20	65.1 ± 6.4/64.3 ± 5.2	3 ± 1.3/3 ± 1.6	MA	Huperzine	MMSE	T = C
Liu et al.⁴⁸	Chinese	2010	MCI	2 + 6	17	19	66.00 ± 6.84/69.32 ± 6.86	2.5 ± 0.93/1.17 ± 0.5	EA	Donepezil	MMSE	T ＞ C
Wang et al.⁷⁸	Chinese	2015	AD	3 + 9	36	36	72.05 ± 3.70/70.31 ± 3.79	3.33 ± 1.98/2.60 ± 1.51	EA	Donepezil	MMSE	T ＞ C
Feng et al.⁵⁴	Chinese	2019	AD	8 + 10	20	20	68 ± 9/69 ± 7	4.23 ± 2.26/4.63 ± 2.48	EA	Donepezil	MMSE	T = C
Yan et al.⁹⁰	Chinese	2014	AD	11	20	20	60∼80/60∼78	＜1y	MA	Donepezil	MMSE	T ＞ C
Gu et al.⁵⁶	Chinese	2014	AD	2 + 3	72	69	75 ± 7/72 ± 7	1.27 ± 0.32/1.34 ± 0.24	MA	Donepezil	MMSE, ADAS-cog	MMSE: T ＞ C ADAS-cog: T ＞ C
Zhao et al.⁹⁴	Chinese	2020	AD	8	25	25	69.52 ± 6.13/69.52 ± 6.13	3.85 ± 0.72/3.85 ± 0.72	MA	Donepezil	MMSE	T ＞ C
Jia et al.⁴⁷	English	2017	AD	2 + 3	43	44	75.11 ± 6.53/74.50 ± 6.83	4.46 ± 0.99/4.42 ± 1.06	MA	Donepezil	ADAS-cog	T ＞ C
Bi et al.⁴⁶	English	2016	AD	2	27	27	71.5 ± 4.7/70.2 ± 4.6	3.2 ± 1.9/3.0 ± 1.4	EA	Donepezil	MMSE	T ＞ C
Feng et al.⁵⁵	Chinese	2023	AD	8 + 10	17	17	68 ± 9/69 ± 7	4.23 ± 2.26/4.63 ± 2.48	EA	Donepezil	HDS	T ＞ C
Jia et al.⁵⁸	Chinese	2017	AD	2 + 3	35	36	75.11 ± 6.53/74.50 ± 6.83	2.42 ± 1.00/2.50 ± 1.02	EA + oral placebo	Donepezil + sham acupuncture (The acupoints were selected at the non-meridian non-acupoint 2 cm apart from the acupoints, and the acupuncture depth was subcutaneous shallow)	ADAS-cog, MMSE	ADAS-cog: T ＞ C MMSE: T ＞ C
Liu et al.⁶⁹	Chinese	2022	AD	8	64	64	62.40 ± 3.39/62.52 ± 3.56	2.96 ± 0.85/2.97 ± 0.84	EA + Donepezil	Donepezil	ADAS-cog	T ＞ C
Liang et al.⁶¹	Chinese	2021	MCI	6 + 15	84	35	65.26 ± 11.02/75.34 ± 10.30	0.51 ± 0.37/0.87 ± 0.66	MA + Donepezil	Donepezil	MMSE, MoCA	MMSE: T ＞ C MoCA: T ＞ C
Xu⁸⁷	Chinese	2021	AD	16	45	45	74.55 ± 5.04/75.82 ± 4.52	3.34 ± 0.61/3.28 ± 0.58	MA + Donepezil	Donepezil	MMSE	T ＞ C
Zhou et al.⁹⁶	Chinese	2021	AD	3 + 12	31	33	75.1 ± 7.0/75.8 ± 6.4	3.2/3.1	EA + Donepezil	Donepezil	MMSE, ADAS-cog	MMSE: T ＞ C ADAS-cog: T ＞ C
Wang et al.⁸⁰	Chinese	2021	AD	13 + 9	50	50	_	—	MA + Rivastigmine	Rivastigmine	MMSE, ADAS-cog	MMSE: T ＞ C ADAS-cog: T ＞ C
Yu⁹¹	Chinese	2020	AD	19	25	25	67.52 ± 4.76/66.25 ± 4.32	7.51 ± 3.65/7.32 ± 2.35	EA + Donepezil	Donepezil	MMSE, MoCA	MMSE: T ＞ C MoCA: T ＞ C
Xia et al., study 1⁸⁴	Chinese	2020	AD	2 + 8 + 17	30	30	49 ± 11/50 ± 12	3.79 ± 0.27/4.07 ± 0.27	EA + Donepezil	Donepezil	MMSE	T ＞ C
Chen et al.⁵²	Chinese	2019	MCI	2 + 5 + 6	30	30	67.77 ± 5.96/70.23 ± 6.92	6.87 ± 1.89/6.47 ± 1.63	MA + Donepezil	Donepezil	MMSE, MoCA	MMSE: T ＞ C MoCA: T ＞ C
Yuan⁹²	Chinese	2019	AD	13	22	22	74.8 ± 3.5/75.8 ± 2.8	0.34 ± 0.05/0.35 ± 0.05	MA + Donepezil	Donepezil	MMSE, MoCA	MMSE: T = C MoCA: T = C
Chen et al.⁵¹	Chinese	2018	AD	8	48	48	74.36 ± 5.47/75.13 ± 5.81	3.42 ± 0.73/3.29 ± 0.68	MA + Donepezil	Donepezil	MMSE	T ＞ C
Li⁶⁰	Chinese	2018	AD	19	31	31	62.41 ± 9.03/61.23 ± 8.37	—	MA + Huperzine	Huperzine	MoCA	T ＞ C
Tao et al.⁷⁶	Chinese	2018	AD	19	45	45	72.21 ± 3.26/72.52 ± 3.25	3.59 ± 0.72/3．58 ± 0．72	MA + Huperzine	Huperzine	MMSE, HDS	MMSE: T ＞ C HDS: T ＞ C
Peng et al.⁷¹	Chinese	2017	AD	2 + 3	25	25	69.4 ± 5.4/69.5 ± 5.3	7.5 ± 1.8/7.6 ± 1.7	EA + Huperzine	Huperzine	MMSE, HDS	MMSE: T ＞ C HDS: T ＞ C
Li et al.⁶⁴	Chinese	2016	AD	18	25	25	(71.4 ± 3.5)	—	EA + Donepezil	Donepezil	MMSE, MoCA	MMSE: T ＞ C MoCA: T ＞ C
Wei et al.⁸²	Chinese	2016	AD	2 + 3	33	33	68.37 ± 5.37/68.71 ± 5.77	7.77 ± 1.65/7.88 ± 1.67	MA + Huperzine	Huperzine	MMSE, HDS	MMSE: T ＞ C HDS: T ＞ C
Wang et al.⁷⁹	Chinese	2016	AD	19	32	32	Total age 65∼87, Mean age 75.2 ± 2.2	—	EA + Donepezil	Donepezil	MMSE, MoCA	MMSE: T ＞ C MoCA: T ＞ C
Sun et al.⁷⁴	Chinese	2012	MCI	2	20	20	65 ± 4/66 ± 5	1.2 ± 0.6/1.5 ± 0.5	MA + Donepezil	Donepezil	MMSE	T ＞ C
Zou et al.⁹⁷	Chinese	2011	AD	19	20	18	63∼86	—	EA + Donepezil	Donepezil	MMSE, MoCA	MMSE: T ＞ C MoCA: T ＞ C
Xu⁸⁶	Chinese	2017	AD	2	30	31	71.38 ± 5.50/72.62 ± 6.43	—	MA + Memantine	Memantine	MMSE	T ＞ C
Wang et al.⁷⁷	Chinese	2014	AD	2	27	28	70.3 ± 8.0/70.7 ± 9.1	5 ± 1.1/5.8 ± 0.6	MA + Donepezil	Donepezil	MMSE, ADAS-cog	MMSE: T ＞ C ADAS-cog: T ＞ C
Xia et al., study 2⁸⁵	Chinese	2020	AD	8	30	28	61 ± 8/62 ± 7	4.32 ± 2.23/4.58 ± 2.12	EA + Donepezil	Donepezil	MoCA, ADAS-cog	MoCA: T ＞ C ADAS-cog: T ＞ C
Pang et al.⁷⁰	English	2022	AD	3	30	30	68.9 ± 8.3/69.7 ± 8.1	2.7 ± 0.6/3.1 ± 0.4	EA + Donepezil	Donepezil	MMSE, ADAS-cog	MMSE: T ＞ C ADAS-cog: T ＞ C
Wang et al.⁸¹	Chinese	2023	AD	11	30	30	78.47 ± 5.10/77.40 ± 4.83	—	MA + Donepezil	Donepezil	MMSE	T ＞ C
Zheng⁹⁵	Chinese	2023	AD	14	48	48	70.21 ± 5.19/69.78 ± 5.45	8.36 ± 1.11/9.01 ± 0.98	MA + Donepezil	Donepezil	MMSE	T ＞ C
Li et al.⁶³	Chinese	2013	MCI	6	39	39	62.8 ± 5.9/61.9 ± 6.8	—	EA + Donepezil	Donepezil	MMSE, MoCA	MMSE: T ＞ C MoCA: T ＞ C
Xu et al.⁸⁹	Chinese	2024	MCI	6	40	40	57.04 ± 3.18/66.24 ± 3.55	—	MA	Sham needling: It involves shallow needling that is not on the meridians or acupoints. It is sufficient as long as the needle does not drop and the skin does not break	MoCA	T ＞ C
Yin et al.⁴⁹	English	2025	MCI	20	20	20	62.65 ± 7.92/62.55 ± 8.91	4.35 ± 2.67/4.12 ± 3.08	MA	No treatment	ADAS-Cog MoCA	ADAS-cog: T ＞ C MoCA: T ＞ C
Shi et al.⁷²	Chinese	2023	MCI	1 + 21	45	45	62.44 ± 3.05/63.12 ± 2.32	1.09 ± 0.16/1.02 ± 0.20	MA	Donepezil	MoCA MMSE	MMSE: T ＞ C MoCA: T = C
Li et al., study 1⁶⁶	Chinese	2024	AD	2 + 22	26	26	69.81± 5.71/70.50 ± 5.55	4.23 ± 1.92/3.92 ± 2.05	MA + Donepezil	Donepezil	MMSE	MMSE: T ＞ C
Wei et al.⁸³	Chinese	2023	AD	23	27	28	71.4 ± 7.7/69.2 ± 8.3	2.08 ± 0.89/1.85 ± 1.05	MA + Donepezil	Donepezil	MMSE ADAS-Cog	MMSE: T ＞ C ADAS-cog: T ＞ C
Li et al., study 2⁶²	Chinese	2024	AD	24	50	50	67.29 ± 4.68/68.82 ± 4.15	5.32 ± 1.19/5.34 ± 1.22	MA + Donepezil	Donepezil	MMSE	MMSE: T ＞ C

T: treatment group; C: control group; RCT: randomized controlled trial; MCI: mild cognitive impairment; AD: Alzheimer's disease; MMSE: Mini-Mental State Examination; MoCA: Montreal Cognitive Assessment; MA: manual acupuncture; EA: electroacupuncture; T = C: The experimental group is not better than the control group, the difference is not significant (p > 0.05); T ＞ C: The experimental group was better than the control group, and the difference was statistically significant (p ≤ 0.05); Study 1 and Study 2 are used to differentiate articles with the same year and the same first author's surname.

Diagnostic criteria: 1. 2018 Chinese Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Disorders (V): Diagnosis and Treatment of Mild Cognitive Impairment; 2. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV/5); 3. National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer Disease and Related Disorders Association (NINCDS-ADRDA); 4. Internal Medicine of Traditional Chinese Medicine; 5. Chinese Expert Consensus on the Prevention and Treatment of Cognitive Dysfunction; 6. Petersen's criteria; 7. Guiding principles of clinical research on mild cognitive impairment (protocol); 8. National Institute on Aging-Alzheimer's Association (NIA-AA); 9. Diagnostic Criteria, Syndrome Differentiation and Typing, and Therapeutic Efficacy Evaluation Criteria for Senile Dementia (Draft for Discussion); 10. Professor Tian Jinzhou's 2012 operational criteria for the diagnosis of Alzheimer's disease (OCDAD) in China; 11. International Classification of Disease (ICD-10); 12. Clinical Diagnosis and Therapeutic Evaluation Standards for Senile Dementia (Trial) in Traditional Chinese Medicine 2011; 13. 2018 Chinese Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Disorders (Part II): Alzheimer's Disease Diagnosis and Treatment Guidelines; 14. Early Diagnosis and Treatment of Alzheimer's Disease; 15. Traditional Chinese Diagnostic Medicine; 16. Staging of Dementia and Diagnostic Criteria for Syndrome Differentiation in Clinical Trials of Traditional Chinese Medicine; 17. International Working Group (IWG-2) diagnostic criteria; 18. Diagnostic criteria related to senile dementia in “Chinese Classification and Diagnostic Criteria for Mental Disorders, third edition (Classification of mental Disorders) (CCMD-3)”; 19. Diagnosed with AD by clinical physicians; 20. the Jak/Bondi 2014 criteria; 21. Criteria for the diagnosis, the differentiation of syndrome and evaluation of vascular dementia for research studies; 22. Guidelines for Clinical Research of New Traditional Chinese Medicine; 23. 2018 Chinese Guidelines for the Diagnosis and Treatment of Dementia and Cognitive Impairment (VII): Risk Factors and Intervention for Alzheimer's Disease; 24. Diagnosis and treatment of Alzheimer's Disease in both traditional Chinese and Western medicine.

Quality assessment of included studies

The bias analysis results are shown in Figures 2 and 3. Of the included studies, 4 articles^46–49 had low risk of bias across all domains, while the remaining 48 articles^50–97 had unclear risk of bias in at least one domain. Of these 48, 8 articles^{58,62,64,65,77,81,94,95} were rated high risk of bias in one of the seven domains: 3 articles^62,64,95 were rated high risk in random sequence generation due to non-random group allocation (grouping by treatment method), and 5 articles^{58,65,77,81,94} were judged to have high risk in other biases.

Figure 2.

Risk of bias summary of included studies. – indicates high risk of bias, + indicates low risk of bias, and ? indicates unclear risk of bias. * was used to distinguish articles with the same year and the same first author's surname.

Figure 3.

Risk of bias graph of included studies.

Specifically, Li et al.⁶⁵ did not report participants’ demographic data (e.g., gender, age, disease duration), with unknown between-group differences; Zhao et al.⁹⁴ had inconsistent total numbers of the intervention group when calculating the effective rate compared to the stated figure in the article, without providing explanations; Wang et al.⁸¹ miscalculated the effective rate of the experimental group; Wang et al.,⁷⁷ reported discrepancies between the sum of effective case count of the control group; Jia et al.⁵⁸ had inconsistencies between the combined sum of case counts for each treatment outcome and cases counts by gender in the control group and the total sample size of the control group stated in the article.

Results of meta-analyses

Acupuncture vs. Blank or Placebos

Five control conditions were used in the included studies including non-acupoints adjacent to the points chosen in the experimental group, no treatment, non-acupuncture placebo needles, non-penetrating sham acupuncture, and oral placebos. Nine articles^{49,50,53,57,65,75,88,89,93} (n = 543; 160 AD patients, 383 MCI patients) were included in this comparison, with manual acupuncture (MA) as the sole acupuncture intervention across all studies. Statistical analysis was performed using a random-effects model, and results are illustrated in Figure 4. Compared with blank or placebos groups, acupuncture significantly improved patients’ overall cognitive function (SMD = 1.09, 95% CI = [0.60, 1.58], p < 0.001, I² = 91.39%) with high heterogeneity among studies.

Figure 4.

Forest plot of acupuncture vs. blank or placebos.

Begg's test, Egger's test, and funnel plot (Figure 5) showed no significant publication bias (Begg's test: p = 0.348; Egger's test: p = 0.374). As shown in Figure 5, the points were roughly symmetrically distributed. The pooled effect size remained unchanged after the trim-and-fill method was applied. The fail-safe N was 463, much larger than the threshold of “5k + 10” (k = 9, number of included studies; 5 × 9 + 10 = 55). This indicates that the significant results were unlikely to be attributed to publication bias.

Figure 5.

Funnel plot (trim and fill) of acupuncture vs. blank or placebos.

The sensitivity analysis (Supplemental Material S2, Figure S2-1) was conducted by sequentially excluding each included study. The 95%CI did not change significantly, indicating that the effect size estimates were stable.

Acupuncture vs. Western medicine

A total of 15 articles^46–48^{,54–56,58,59,67,68,72,73,78,90,94} (n = 873; 689 AD patients, 184 MCI patients) were included. Statistical analysis was performed using a random-effects model, with results illustrated in Figure 6. Compared with the Western medicine group, acupuncture significantly improved patients’ overall cognitive function (SMD=0.45, 95% CI = [0.22, 0.67], p < 0.001, I² = 69.38%) with moderate-to-high heterogeneity among studies.

Figure 6.

Forest plot of acupuncture vs. Western medicine. Study 1 and Study 2 are used to differentiate articles with the same year and the same first author's surname.

Begg's test, Egger's test, and funnel plot (Figure 7) suggested a potential publication bias trend (Begg's test: p = 0.075; Egger's test: p = 0.096). After applying the trim-and-fill method, the small effect size indicates no significant difference in the impact of acupuncture and Western medicine on overall cognitive function (SMD=0.242, 95%CI = [-0.010, 0.494]). However, the fail-safe N was 158, much larger than the “5k + 10” threshold (k = 15, number of included studies; 5 × 15 + 10 = 85). This indicates that the findings, though statistically no-significant and suggesting a trend of better overall cognitive function in the acupuncture group than the control group, were unlikely due to publication bias. Inconsistent findings across methods highlight the need for caution in interpreting these results.

Figure 7.

Funnel plot (trim and fill) of acupuncture vs. Western medicine.

Sensitivity analysis (Supplemental Material S2, Figure S2-2) was conducted by sequentially excluding each included study. The 95%CI did not change significantly, indicating that the effect size estimates were stable.

Acupuncture combined with western medicine vs. Western medicine

A total of 28 articles^{51,52,60–64}^{,66,69–71,74,76,77,79–87,91,92,95–97} (n = 1946; 1649 AD patients, 297 MCI patients) were included. Statistical analysis was performed using a random-effects model, with results illustrated in Figure 8. Compared with Western medicine alone, acupuncture combined with Western medicine significantly improved patients’ overall cognitive function (SMD = 1.18, 95% CI = [0.92, 1.44], p < 0.001, I² = 90.73%) with high heterogeneity among studies.

Figure 8.

Forest plot of acupuncture combined with western medicine vs. Western medicine. Study 1 and Study 2 are used to differentiate articles with the same year and the same first author's surname.

Begg's test, Egger's test, and funnel plot (Figure 9) indicated significant publication bias (Begg's test: p = 0.001; Egger's test: p = 0.003). After applying the trim-and-fill procedure, the pooled effect size remained significant (SMD=0.94, 95%CI = [0.65, 1.23]). The fail-safe N was 5285, for exceeding the “5k + 10” threshold (k = 28, number of included studies; 5k + 10 = 150). This indicates that that though publication bias may exist, it could not account for the significant results.

Figure 9.

Funnel plot (trim and fill) of acupuncture combined with western medicine vs. Western medicine.

Sensitivity analysis (Supplemental Material S2, Figure S2-3) was conducted by sequentially excluding each included study. The 95%CI did not change significantly, indicating that the effect size estimates were stable.

Subgroup analyses

Type of participants

Subgroup analyses by patient type were performed for the three aforementioned contrasts, with results presented in Table 2 and Supplemental Material S2, Figure S2-4.

Table 2.

Subgroup analysis results for patient type and acupuncture stimulation methods.

	k	N	SMD	Z	p	95%CI	Q	p
Type of participant
Acupuncture vs. blank or placebos
AD	2	160	1.13	2.47	0.013	(0.23, 2.03)	7.07	0.008
MCI	15	383	1.20	5.41	＜0.001	(0.77, 1.64)	102.29	＜0.001
Acupuncture vs. Western medicine
AD	14	689	0.45	3.47	0.001	(0.20, 0.70)	45.52	＜0.001
MCI	5	184	1.02	1.37	0.171	(−0.44, 2.48)	105.82	＜0.001
Total between							0.57	0.450
Acupuncture combined with Western medicine vs. Western medicine
AD	38	1649	1.20	9.35	＜0.001	(0.95, 1.45)	303.57	＜0.001
MCI	7	297	0.70	7.67	＜0.001	(0.52, 0.87)	2.06	0.914
Total between							10.20	0.001
Type of stimulation
Acupuncture vs. Western medicine
EA	8	309	0.49	4.44	＜0.001	(0.27, 0.70)	4.98	0.663
MA	11	564	0.68	2.39	0.017	(012, 1.23)	148.30	＜0.001
Total between							0.38	0.536
Acupuncture combined with Western medicine vs. Western medicine
EA	18	640	1.23	5.76	＜0.001	(0.81, 1.65)	166.12	＜0.001
MA	27	1306	1.04	8.59	＜0.001	(0.81. 1.28)	154.11	＜0.001
Total between							0.57	0.449

MA: Manual acupuncture; EA: electroacupuncture.

In the acupuncture vs. blank or placebos contrast, acupuncture significantly improved overall cognitive function in MCI patients (SMD = 1.20, 95% CI = [0.77, 1.64], p < 0.001, I² = 86.31%) and AD patients (SMD=1.13, 95% CI = [0.23, 2.03], p < 0.05, I² = 85.86%) compared to controls. However, only 2 articles^57,88 were included in the AD subgroup; therefore, moderator effect analysis was not conducted for this contrast.

In the acupuncture vs. Western medicine contrast, acupuncture significantly improved overall cognitive function in AD patients compared to the Western medicine (SMD = 0.45, 95% CI = [0.20, 0.70], p = 0.001, I² = 71.44%). However, acupuncture did not significantly improve overall cognitive function in MCI patients (SMD = 1.02, 95% CI = [−0.44, 2.48], p > 0.05, I² = 96.22%), exhibiting extremely high heterogeneity in the MCI subgroup. Moderator effect analysis showed no significant difference in the therapeutic effect on overall cognitive function between AD and MCI patients in this contrast (Q = 0.57, p = 0.450). All results are presented in Table 2 and Supplemental Material S2, Figure S2-5.

In the acupuncture combined with medication vs. medication control contrast, acupuncture combined with medication significantly improved overall cognitive function in both AD and MCI patients compared to medication alone (AD: SMD = 1.20, 95% CI = [0.95, 1.45], p < 0.001, I² = 87.81%; MCI: SMD = 0.70, 95% CI = [0.52, 0.88], p < 0.001, I² = 0%). Moderator effect analysis showed that the therapeutic effect on overall cognitive function was superior in AD patients than in MCI patients in this contrast (Q = 10.20, p = 0.001). All results are presented in Table 2 and Supplemental Material S2, Figure S2-6.

Type of stimulation

MA method was used in all the 9 articles^{49,50,53,57,65,75,88,89,93} included in the acupuncture vs. blank or placebos contrast, so subgroup analysis by stimulation type was not feasible. Subgroup analyses by stimulation type (MA/EA) were conducted for the latter two contrasts (acupuncture vs. Western medicine, and acupuncture combined with Western medicine vs. Western medicine alone), with results presented in Table 2.

In the acupuncture vs. Western medicine contrast, both EA and MA exerted a moderate effect in improving overall cognitive function compared to Western medicine (EA: SMD = 0.49, 95% CI = [0.27, 0.70], p < 0.001, I² = 0%; MA: SMD=0.68, 95% CI = [0.12, 1.23], p < 0.05, I² = 93.26%), with extremely high heterogeneity in the MA subgroup (Table 2, Supplemental Material S2, Figure S2-7). However, moderator effect analysis showed no significant difference in therapeutic effect between EA and MA (Q = 0.38, p = 0.536) (Table 2).

In the acupuncture combined with Western medicine vs. Western medicine alone contrast, both EA and MA combined with Western medicine significantly improved overall cognitive function compared to Western medicine alone (EA: SMD = 1.23, 95% CI = [0.81, 1.65], p < 0.001, I² = 89.77%; MA: SMD = 1.04, 95% CI = [0.81, 1.28], p < 0.001, I² = 83.13%), with extremely high heterogeneity in the EA combined with Western medicine subgroup (Table 2, Supplemental Material S2, Figure S2-8). Moderator effect analysis showed no significant difference in therapeutic effect between the two acupuncture types (Q = 0.57, p = 0.449) (Table 2).

Discussion

This meta-analysis evaluated the effects of acupuncture on overall cognitive function in patients with AD and MCI. The pooled results demonstrated that acupuncture was effective in improving overall cognitive function across these AD spectrum disorders. Specifically, for AD patients, acupuncture, whether as a standalone therapy or combined with Western medicine, resulted in greater cognitive improvement than control interventions, a benefit observed for both EA and MA. In contrast, for MCI patients, acupuncture alone was superior to control interventions but did not differ significantly from Western medicine in efficacy. Furthermore, when combined with Western medicine, the intervention effect was more pronounced in AD patients than in MCI patients.

Effects of acupuncture on different stages of dementia

Effects of acupuncture for AD

Previous studies^20,98–101 have shown that acupuncture could improve cognitive function in AD. In the International Clinical Practice Guidelines for Traditional Chinese Medicine - Alzheimer's Disease (2019), the World Federation of Chinese Medicine and the China Association of Chinese Medicine included acupuncture as level III evidence (Grade D recommendation) for non-pharmacological interventions in AD.⁹⁸ A Delphi expert consensus,²⁰ based on low/very low GRADE evidence, recommends acupuncture as an adjuvant therapy for mild-to-moderate cognitive impairment due to AD to improve cognitive domains (e.g., memory, attention, comprehension, linguistic ability, etc.). Additionally, the latest Chinese expert consensus on multimodal rehabilitation intervention for AD⁹⁹ strongly recommends tailored traditional Chinese medicine and acupuncture based on AD stages to enhance cognitive function, improve quality of life, and delay disease progression (moderate evidence quality).

Consistent with these recommendations, the present study confirms that acupuncture effectively improves overall cognitive function in AD patients. Specifically, acupuncture alone has a better effect in improving the overall cognitive function of patients with AD compared to Western medicine monotherapy, and acupuncture combined with Western medicine significantly outperformed Western medicine alone, findings that aligned with previous research.^100,101 To a certain extent, these results further strengthen the evidence base for the aforementioned guidelines and consensus recommendations.

However, some prior meta-analyses^100–104 have reported inconsistent conclusions regarding the efficacy of acupuncture relative to Western medicine, a discrepancy that may stem from heterogeneity in control group medication selection. Specifically, previous meta-analyses^101,103,104 included a variety of drugs in the control group, both Chinese and Western drugs (e.g., donepezil, piracetam, Yizhi Jiannao Tablets, nimodipine, hydergine, duxil, Huperzine A, Naofukang Tablets, Danggui Shaoyao powder, Jian nao San). In contrast, the control group in this study was restricted to five first-line symptomatic agents including four FDA-approved drugs (donepezil, rivastigmine, galantamine, memantine) and huperzine A, all of which are recommended as first-line treatments in the Chinese Guidelines for the Diagnosis and Treatment of AD.³⁰ This targeted selection of control medications enhances the comparability and clinical relevance of our findings, addressing a key limitation of prior studies.

Effects of acupuncture for MCI

Lai et al.¹⁰⁵ suggested that acupuncture may serve as an effective non-pharmacological intervention for MCI of AD origin. Using a network meta-analysis approach with the MMSE and ADAS-Cog as outcome measures, they evaluated nine interventions, including medications (acetylcholinesterase inhibitors, ginkgo biloba, nimodipine, Chinese herbal medicine), non-pharmacological treatments (acupuncture, music therapy, exercise therapy, nutritional therapy), and placebo, for improving overall cognitive function in MCI patients. Acupuncture ranked second among all interventions for MMSE outcomes and first for ADAS-Cog outcomes. Additionally, a Delphi expert consensus²⁰ (based on low/very low GRADE evidence) recommends acupuncture for the management of subjective cognitive decline (SCD) or MCI.

However, some previous studies^{10,19,106,107} reported that acupuncture is more effective than medication for MCI, a finding slightly inconsistent with ours. This discrepancy arises because previous studies^19,106 classified acupuncture alone and acupuncture combined with other interventions (e.g., Chinese herbal medicine, Western medicine, cognitive training) under “acupuncture”, leading to overly general conclusions. In contrast, the present study separately analyzed acupuncture monotherapy and acupuncture combined with medication, and further performed subgroup stratification by patient type (AD vs. MCI), and the conclusions were more detailed and targeted.

Notably, despite a certain degree of publication bias in this study, Orwin's fail-safe N analysis indicates that the results were not attributed to publication bias. Furthermore, excluding 8 articles^{58,62,64,65,77,81,94,95} identified as high-risk factors in quality assessment had no impact on the meta-analysis results (Supplemental Material S3), confirming the robustness of our conclusions.

Effects of the types of acupuncture stimulation

Two acupuncture modalities were included in this study including EA and MA. EA involves inserting acupuncture needles into acupoints to deliver weak electrical stimulation, and the synergy between acupuncture and electrical stimulation enhances the overall therapeutic response.¹⁰⁸ The present study demonstrated that MA alone, EA alone, and both combined with Western medicine significantly improved overall cognitive function compared to Western medicine monotherapy; however, no significant difference in cognitive improvement was observed between MA and EA. Notably, after excluding 8 articles^{58,62,64,65,77,81,94,95} identified as having high-risk factors in quality assessment, subgroup analysis of the acupuncture alone versus Western medicine group showed that MA trended to be superior to Western medicine (p = 0.082), while EA was significantly superior to Western medicine (p < 0.001) (Supplemental Material S3).

These findings are subject to certain confounding factors. For instance, EA employs continuous 20-min stimulation, whereas MA involves multiple techniques each lasting only a few seconds. Such differences in stimulation duration and periodicity (including intermittent versus continuous) may modulate biological progress such as cellular signal transduction, gene expression, and tissue plasticity, thereby potentially influencing the comparative efficacy of MA and EA.¹⁰⁹

Despite these limitations, the significant efficacy of EA endows it with substantial value for promoting acupuncture intervention schemes. This is because EA is easy to operate, features accurately adjustable and quantifiable treatment intensity, and does not require dedicated acupuncturists, in contrast to MA interventions. Additionally, EA parameters can be better quantified, and different stimulation parameters (including electrical pulse type, applied voltage and current magnitude, stimulation frequency, and continuous versus intermittent mode) may yield distinct effects.¹¹⁰ This parameter-dependence highlights the need for in-depth exploration of optimal EA parameter combinations in future research to enhance the stability and individualization of acupuncture efficacy.

Potential mechanisms of acupuncture on AD/MCI

Beyond clinical efficacy, acupuncture exerts its effects in AD/MCI through several potential mechanisms. Anatomically, over 80% of authentic acupoints correspond to intermuscular or intramuscular connective tissue planes.¹⁶ Acupuncture manipulations (e.g, rotation and lifting-thrusting) induce “de qi” (needle sensation) via connective tissue entanglement, converting mechanical stimulation into biochemical signals to regulate central nervous system function.¹⁶ In core pathological regulation, EA exerts effects via specific pathways that include activating transcription factor EB (TFEB) through the Akt-MAPK1-MTORC1 pathway to promote Aβ degradation^111–113; reducing phosphorylated tau levels via the PI3K/Akt/GSK-3β pathway^111,114,115; inhibiting microglial activation and inflammatory factors release through the HMGB1/TLR4 and RAGE/NADPH oxidase pathways to alleviate neuroinflammation^{111,116–118}; and simultaneously enhancing synaptic plasticity,^12,22 increasing hippocampal synapses density, and promoting neurogenesis to improve cognitive function.^111,119

In addition, acupuncture can regulate the blood-brain barrier (BBB), a newly identified therapeutic target for apolipoprotein E (APOE4)-associated cognitive decline (independent of Aβ or tau pathology).¹²⁰ EA can enhance BBB permeability, which not only facilitates the entry of Aβ/tau-targeting macromolecules drugs into the brain¹²¹ and assists in endogenous Aβ clearance,^121–123 but also lays a foundation for acupuncture as an adjuvant to pharmacotherapy. Studies have confirmed that EA can improve cognitive impairment and reduce BBB permeability in AD model mice¹¹⁸; specific EA modalities can also mediate the delivery of nerve growth factor across the hippocampal BBB via the p65-VEGFA-TJs pathway,¹²⁴ among which sparse-dense wave is the potential frequency for BBB regulation.^110,122,123

It should be noted that current mechanisms studies on acupuncture for AD/MCI are mostly based on mouse models. While multi-directional mechanisms remain preliminary, and the synergy or interaction between them is not fully understood.

Limitations and future directions

This study has several limitations. First, the nature of acupuncture (e.g., manual operation, physical stimulation) complicates participant blinding, limiting the number of low-bias studies. Second, included RCTs inadequately complied with the Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA),²³ omitting key details such as needle type, acupoint selection rationale and acupuncturist qualifications. Third, studies were geographically concentrated (mostly in China), and used heterogeneous controls between acupuncture and blank or placebos (e.g., non-acupoints, no intervention, placebo needles, or oral placebos), potentially affecting placebo comparisons.¹⁸ Fourth, significant heterogeneity and varying methodological quality warrant cautious interpretation. Finally, long-term efficacy data are lacking.

High-quality, multicenter, large-sample RCTs across diverse countries, strictly adhering to STRICTA, are urgently needed. These would improve enhance credibility, generalizability and reduce heterogeneity. Advancing technology could also integrate artificial intelligence into this research,¹⁷ facilitating the modernization of traditional Chinese medicine for clinical application.

Conclusions

This meta-analysis, based on evidence-based medicine principles, examined acupuncture's effects on cognitive function in AD spectrum disorders. Current evidence indicates acupuncture effectively improves overall cognitive function in MCI and AD; acupuncture combined with Western medicine is significantly more effective than Western medicine alone for advanced dementia. Acupuncture can serve as an effective adjuvant intervention for AD, and a short-term cognitive improvement alternative for some patients with Western medicine contraindications. Both MA and EA improve cognitive function. Future RCTs on acupuncture for MCI and AD need refined design to enhance evidence quality and guide clinical practice more effectively.

Supplemental Material

sj-docx-1-alz-10.1177_13872877261438495 - Supplemental material for The interventional effect of acupuncture on overall cognitive function in Alzheimer's disease spectrum disorders: A meta-analysis

Supplemental material, sj-docx-1-alz-10.1177_13872877261438495 for The interventional effect of acupuncture on overall cognitive function in Alzheimer's disease spectrum disorders: A meta-analysis by Yifan Chen, Shenggang Zhao, Fenglei Yang, Ya Wang, Zhenxiang Han, Fang Han, Zhiqun Wang, Zhenbo Chen, Kai Sun, Peipeng Liang and Kuncheng Li in Journal of Alzheimer's Disease

Supplemental Material

sj-docx-2-alz-10.1177_13872877261438495 - Supplemental material for The interventional effect of acupuncture on overall cognitive function in Alzheimer's disease spectrum disorders: A meta-analysis

Supplemental material, sj-docx-2-alz-10.1177_13872877261438495 for The interventional effect of acupuncture on overall cognitive function in Alzheimer's disease spectrum disorders: A meta-analysis by Yifan Chen, Shenggang Zhao, Fenglei Yang, Ya Wang, Zhenxiang Han, Fang Han, Zhiqun Wang, Zhenbo Chen, Kai Sun, Peipeng Liang and Kuncheng Li in Journal of Alzheimer's Disease

Supplemental Material

sj-docx-3-alz-10.1177_13872877261438495 - Supplemental material for The interventional effect of acupuncture on overall cognitive function in Alzheimer's disease spectrum disorders: A meta-analysis

Supplemental material, sj-docx-3-alz-10.1177_13872877261438495 for The interventional effect of acupuncture on overall cognitive function in Alzheimer's disease spectrum disorders: A meta-analysis by Yifan Chen, Shenggang Zhao, Fenglei Yang, Ya Wang, Zhenxiang Han, Fang Han, Zhiqun Wang, Zhenbo Chen, Kai Sun, Peipeng Liang and Kuncheng Li in Journal of Alzheimer's Disease

Footnotes

Acknowledgements

We would like to thank Dong Ding and Xinrui Cui for their assistance in compiling the data.

ORCID iDs

Yifan Chen

Ya Wang

Zhenxiang Han

Fang Han

Zhiqun Wang

Zhenbo Chen

Kai Sun

Peipeng Liang

Kuncheng Li

Ethical considerations

Not applicable.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Author contribution(s)

Yifan Chen: Data curation; Formal analysis; Investigation; Methodology; Validation; Visualization; Writing – original draft; Writing – review & editing.

Shenggang Zhao: Data curation; Investigation; Methodology; Validation; Writing – review & editing.

Fenglei Yang: Conceptualization; Methodology; Supervision; Writing – review & editing.

Ya Wang: Formal analysis; Methodology; Supervision; Writing – review & editing.

Zhenxiang Han: Conceptualization; Writing – review & editing.

Fang Han: Conceptualization; Writing – review & editing.

Zhiqun Wang: Conceptualization; Writing – review & editing.

Zhenbo Chen: Methodology; Resources; Validation; Writing – review & editing.

Kai Sun: Conceptualization; Funding acquisition; Writing – review & editing.

Peipeng Liang: Conceptualization; Funding acquisition; Methodology; Project administration; Resources; Supervision; Writing – review & editing.

Kuncheng Li: Conceptualization; Project administration; Writing – review & editing.

Funding

This study was supported by the National Key Research and Development Project of China (2023YFC3605005, 2020YFC2007302), the Beijing Outstanding Young Scientists Program (JWZQ20240201004), Natural Science Foundation of China (grant numbers 81873892), and the Key Project of Medical and Health Technology of Longgang District, Shenzhen (grant number LGKCYLWS2022034).

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

All data generated or analyzed during this study are included in this published article and its Supplemental Material.

Supplemental material

Supplemental material for this article is available online.

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