Effects of acupuncture on dementia: An overview of systematic reviews

Introduction: The published evidence on the effectiveness and safety of acupuncture on people with dementia has been inconsistent. This systematic review of overviews aims to summarize and evaluate the evidence from relevant systematic reviews (SRs) and meta-analyses to provide reliable evidence for future clinical treatment. Methods: We searched PubMed, EMBASE, Web of Science, Cochrane Library, Cochrane Database of Systematic Reviews, DARE, Google Scholar, CNKI, VIP, CBM and Wangfang from the establishment of the databases to January 2020. The types of dementia based on pathology mainly include Alzheimer's disease (AD) and vascular dementia (VD). We included SRs of randomized controlled trials (RCTs) to assess the effect and safety of acupuncture on different outcomes in patients with dementia in our search. We assessed methodological quality of the included SRs using AMSTAR2, reporting quality using the PRISMA checklist, and quality of evidence of the outcomes using GRADE. Intraclass correlation coefficient (ICC) was used to test the consistency of the results of two evaluators. Results: Thirteen SRs with meta-analyses ma the inclusion criteria, including a total of 137 RCTs and 9012 participants. The results suggested that acupuncture has beneficial effects on effectiveness, cognitive ability, and activities of daily living in the treatment of dementia for 4-24 weeks, although there was a high degree of heterogeneity. Subgroup analysis showed that acupuncture was more effective in treating VD than AD. Further analyses also revealed that single acupuncture treatment was superior to combination treatments and that the safety of acupuncture was significantly higher than that of drug treatments. The quality of reports was rated "high" in one SR, "moderate" in five SRs, and "low" in seven SRs. The methodological quality of only one SR was "low," and the rest were rated "very low." The quality of evidence was rated "high" in one SR, including the effectiveness rate, MMSE, ADAS-cog, HDS, MoCA and FAQ. Conclusion: Acupuncture showed potential therapeutic effects for patients with dementia, but the quality of the evidence was not high. Higher-quality RCTs are warranted to confirm the clinical effects of acupuncture in the treatment of dementia.