Abstract
Background: Alzheimer’s disease (AD) is the most common cause of dementia. However, none of medical treatment can stop or reverse the underlying neurodegenerative of AD at present. Acupuncture has attracted more and more attention in recent years due to its efficacy and very few side effects. Lately, a systematic review has thought that the evidence on the effectiveness of acupuncture in improving the cognitive function of AD patients was not powerful enough. Therefore, the aim of this study is to explore the efficacy and safety of acupuncture in patients with mild to moderate AD.
Methods: This was a randomized, controlled, parallel-group, exploratory study with 4-week baseline (T0), 12week treatment phase (T1) and 12-week follow-up period (T2). Patients with mild to moderate AD meeting the included criteria were randomly allocated into either acupuncture or donepezil hydrochloride groups. The acupuncture group(AG) was given acupuncture treatment three times per week and the donepezil hydrochloride group(DG) group was administered donepezil hydrochloride once daily (5 mg/day for the first 4 weeks and 10 mg/day thereafter). Primary efficacy was measured using Alzheimer’s disease Assessment Scale-Cognitive (ADAS-cog) and Clinician’s Interview-Based Impression of Change-Plus (CIBIC-Plus). The second outcomes were measured with 23-Item Alzheimer’s disease Cooperative Study Activities of Daily Living Scales (ADAS-ADL23) and Neuropsychiatric Index (NPI).
Interventions The treatment strategies for acupuncture was initiated by Professor Jingxian Han during long theoretical study and clinical experience according to the Sanjiao theory of TCM. Then, three experienced acupuncture specialists (zhilongzhang, jianchunyu, yong tang) discussed and finalized the treatment strategies in a consensus process. The acupuncture therapy was performed by nine acupuncturists who are registered Chinese medicine practitioners of the Ministry of Health of the People’s Republic of China and have more than 6 years (median 7.2 years) of clinical experience. The sterile, disposable needles (Huatuo, Suzhou Medical Instruments Factory, China) were used in this study with a diameter of 0.25 mm and a length of 40 mm. These acupoints were employed as basic acupuncture formulas, including RN17(danzhong), RN12(zhongwan), RN6(qihai), ST36(zusanli), SJ5(waiguan) and SP10(xuehai). Moreover, the following acupoints could be selected as auxiliary acupoints according to patient’s symptoms and tongue manifestation,LR3(taichong),GB39(xuanzhong),ST40(fenglong),BL17(geshu),ST44(neiting),
ST25(tianshu) andRN4(guan yu an). Except for RN17, RN12, RN6, RN4, the other acupoints were bilateral. Acupuncture prescriptions were individualized to each patient, and different points were used based on the discretion of the acupuncturist. During acupuncture, patients would have a needling feeling of numbness, tingling, swelling or muscle weakness, which is known as “de qi” and considered as indicators of effective needling. To evoke needle sensation, the needles were inserted obliquely and upward 15 mm into RN17, 15~25 mm perpendicularly into RN12, RN6 and ST36, then rotated at small-amplitude and highfrequency with reinforcing method for 30s. The needles were inserted perpendicularly 15~25 mm into SJ5, then rotated with normal reinforcement and normal reduction method for 30 s. For SP10, the needle was inserted obliquely 15~25 mm into the acupoint, then rotated with big-amplitude and low-frequency reducing method for 30s. The needles would be retained in situ for 30 min. Acupuncture treatment was given three times weekly for 12 weeks. Any additional therapies for AD were not permitted during the entire study period, and only necessary explanations were provided to patients to avoid biased data. All acupuncturists received operation instructions from professor Han, a videotape, and a brochure with detailed information on acupuncture treatment. The patients in the DG group received 5 mg/day of donepezil hydrochloride(Aricept®, Weicai (China) Pharmaceutical Co., Ltd) for the first 4 weeks and 10 mg/day thereafter [15].
Results: Of 87 participants enrolled in the study, 79 patients finished their treatment and follow-up processes. The ADAS-cog scores for AG group showed obvious decreases at T2 and Δ(T2-T0)when compared with DG group, and significant between-group differences were detected (all p <0.05). The mean CIBIC-Plus values for the AG group at T1 and T2 were much lower than that for the DG group, and there were significant differences between the two groups ( <0.05). There were no significant between-group differences in the scores of ADAS-ADL23 and NPI during the study period. Treatment discontinuations due to adverse events were 0 (0%) and 4 (9.09%) for the AG and DG groups, respectively.
Conclusions: Acupuncture is safe, well tolerated and effective in improving the cognitive function, global clinical status of AD.
Quelle: Jia et al. BMC Complementary and Alternative Medicine (2017) 17:556