Stimulated by Wang et al 2024.[1]
SCD – subjective cognitive decline
IF – impact factor
SCDQ – subjective cognitive decline questionnaire
MMSE – mini mental state examination
MCI – mild cognitive impairment
AD – Alzheimer’s disease
EA – electroacupuncture
AVLT – auditory verbal learning test
TMT – trail making test
AFT – animal fluency test
BNT – Boston naming test
SCWT – Stroop colour word test
DSST – digit symbol substitution test
DST – digit span test
CDT – clock drawing test
MoCA – Montreal cognitive assessment
GDS – geriatric depression scale
PSQI – Pittsburgh sleep quality index
FA – fractional anisotropy
MD – mean diffusivity
DC – degree centrality
aDC – area under the curve of DC
DMN – default mode network– key to acronyms
I almost overlooked this paper. There are quite a lot of papers on acupuncture for dementia, both clinical papers and experimental ones using rodent models, and I generally avoid them. I saved this one because the journal seemed quite orthodox (IF 7.2), and I recognised the last author from previous good quality acupuncture research (Lui Cun-Zhi).[2–5] I have highlighted his research here previously: VCIND; Functional dyspepsia 2020; Frequency of Rx in OAK; Intensive EA/MA in OAK.
The study randomised 72 patients with SCD (SCDQ score >5, but MMSE in normal range) to 20 sessions of acupuncture or sham over 12 weeks. Outcomes were measured using both a battery of neuropsychological tests and MRI before and after the course of treatment.
Individuals with SCD have a 40% to 62% risk of developing MCI or AD within 3 years.
The acupuncture points used were both midline points: GV20, GV24, GV16, CV17, CV12, CV6; and bilateral points: GB20, PC6, HT5, SP10, ST36, KI6, BL15, BL45. The 3 points on the back (GV16, BL15, BL24) were stimulated manually with the patient sat up and removed immediately. EA was performed across GV20 and GV24 at 2/100Hz for 20 minutes at an intensity between 0.1 and 1.0mA. The sham acupuncture protocol employed adhesive pads and non-penetrating blunt needles applied at sham points with 2 exceptions. One sham point was on the scalp within the hair, so an adhesive pad could not be used. At this point a needle was inserted superficially and not stimulated. 2 sham points on the back were stimulated briefly with blunt needles and adhesive pads were not used. Non-penetrating sham EA was applied to 2 sham points on each side of the forehead.
The primary outcome was something called the composite Z score, which is a measure of global cognitive function. It was an average of 8 different tests: AVLT, TMT, AFT, BNT SCWT, DSST, DST, CDT. Participants also filled out the following assessment, questionaire, examination, scale, and index: MoCA, SCDQ, MMSE, GDS, and PQSI.
MRI assessments included the volume of the hippocampus, FA and MD of white matter tracks related to the hippocampus, and functional connectivity measures related to the hippocampus, including something called degree centrality (DC). Hippocampal DC is a measure of how the hippocampus connects with all other brain regions under a specific threshold (ie in the background – that is an MC interpretation).
FA and MD have been discussed before here: Rewiring the brain with acupuncture; and here: Acupuncture and DTI 2022.
Cognitive function improved significantly in the acupuncture group compared with the sham group in both the composite Z score and the MoCA. Perhaps more dramatic was the fact that the hippocampi grew bigger (like London taxi drivers studying ‘the knowledge’) in the acupuncture group and shrank in the sham group on both sides of the brain. The differences were statistically significant when measured in total and on each side individually.
When it came to white matter integrity (measured by FA and MD) in most areas assessed there was no difference between groups. Across 5 different tracts there were no differences in FA changes. There was a significant difference in one of those 5 on MD – the stria terminalis of the left fornix. It is possible that more differences would show up with greater statistical power and a longer course of treatment.
Finally, hippocampal aDC significantly improved in the acupuncture group compared with the sham group, but this was only on the left side. The changes were mostly in FC between the hippocampus and DMN structures. Interestingly, the DMN brain structures are the sites where amyloid-β begins to accumulate in AD.[6–8]
References
1 Wang X, Zhou H, Yan C-Q, et al. Cognitive and Hippocampal Changes in Older Adults With Subjective Cognitive Decline After Acupuncture Intervention. Am J Geriatr Psychiatry. Published Online First: 7 March 2024. doi: 10.1016/j.jagp.2024.03.001
2 Liu C-Z, Xie J-P, Wang L-P, et al. Immediate Analgesia Effect of Single Point Acupuncture in Primary Dysmenorrhea: A Randomized Controlled Trial. Pain Med. 2011;12:300–7.
3 Yang J-W, Shi G-X, Zhang S, et al. Effectiveness of acupuncture for vascular cognitive impairment no dementia: a randomized controlled trial. Clin Rehabil. Published Online First: January 2019. doi: 10.1177/0269215518819050
4 Yang J, Wang L-Q, Zou X, et al. Effect of Acupuncture for Postprandial Distress Syndrome. Ann Intern Med. Published Online First: May 2020. doi: 10.7326/M19-2880
5 Tu J-F, Yang J-W, Shi G-X, et al. Efficacy of Intensive Acupuncture Versus Sham Acupuncture in Knee Osteoarthritis: A Randomized Controlled Trial. Arthritis Rheumatol. 2021;73:448–58.
6 Han F, Liu X, Mailman RB, et al. Resting-state global brain activity affects early β-amyloid accumulation in default mode network. Nat Commun. 2023;14:7788.
7 Giorgio J, Adams JN, Maass A, et al. Amyloid induced hyperexcitability in default mode network drives medial temporal hyperactivity and early tau accumulation. Neuron. 2024;112:676-686.e4.
8 Zhang Y, Xue L, Zhang S, et al. A novel spatiotemporal graph convolutional network framework for functional connectivity biomarkers identification of Alzheimer’s disease. Alzheimers Res Ther. 2024;16:60.
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