Stimulated by Kong et al 2026.[1]
AD – Alzheimer’s disease
RCT – randomised controlled trial
IF – impact factor
CDR – clinical dementia rating
MA – manual acupuncture
EA – electroacupuncture
ADAS-cog 12 – AD assessment scale, cognitive subscale, 12 item version
MMSE – mini mental state examination (less sensitive than ADAS-cog 12)
ADCS-ADL23 – AD cooperative study activities of daily living, 23 item version
NPI – neuropsychiatric inventory– key to acronyms
This is a moderately large (n=160) RCT of acupuncture versus a non-penetrating sham control in patients with mild AD who were already taking 5mg of the acetylcholinesterase inhibitor donepezil. It was published in the Journal of Alzheimer’s Disease (IF 3.1) towards the end of March 2026, and it comes from Shanghai.
Eligible participants were aged between 50 and 80 and met the diagnostic criteria for AD with a CDR global score of 1.0.
Acupuncture (MA plus EA) was performed 3 times a week for 14 weeks followed by 14 further weeks of follow-up. The points used included GV20, Yintang, GV24, PC6, HT7, ST36, KI3, and SP6. Supplementary points were added based on TCM syndrome. These were GB39 (brain marrow deficiency pattern) or CV6 (Qi and blood deficiency pattern) or ST40 (phlegm obstruction pattern) or SP10 (blood stasis pattern). EA was applied from GV20 to GV24, and from PC6 to HT7 on each side using a ‘dilatational wave’ of 10/50 Hz at a tolerable intensity. I think this means that the frequency gradually rose from 10 Hz to 50 Hz and back (although the protocol refers to ‘dense dispersed’, which is different). Manual stimulation was applied to the other needles every 15 minutes, and the sessions lasted a total of 45 minutes each.
The sham group had blunt needles applied ‘through plastic rings’ (the same plastic rings were used in the acupuncture group). Sham points were used on the back (2 points over the loin on each side) and over the lateral gastrocnemius. The back points were attached to an EA device, but the wires were disconnected inside a connection part of the leads.
The primary outcome was the change from baseline to week 14 in the ADAS-cog 12 (Chinese version), which ranges from 0 to 75 with higher scores indicating greater cognitive impairment. Secondary outcomes included the change from baseline to week 28 in the ADAS-cog 12, and changes in the MMSE, ADCS-ADL23, and NPI.
The real acupuncture group was 1.5 points better than the sham group at week 14 in the ADAS-cog 12 change from baseline. This was very highly statistically significant, but the size of the change is probably of borderline clinical relevance and the difference disappeared within the first 7 weeks of the follow-up period. The MMSE showed a similar pattern of response although the graph is the other way around. The difference was only significant at 7 weeks into the treatment phase and it was less than 0.5 points, which is not clinically relevant. There were no differences in the other 2 outcome measures at any time point, although they both demonstrated some deterioration in this sample of mild AD patients, as would be expected from natural history alone.
Despite the fact that the size of the changes was of minimal clinical relevance, it is of some academic interest that when the results were examined through the lens of the 4 TCM syndromes into which the patients were allocated, a difference emerged. In the patients categorised as Qi and blood deficiency pattern (21 real, 26 sham), the significant difference in change from baseline of the ADAS-cog 12 was maintained throughout the follow-up period. In the 3 other patterns, there was no persistence in the effect seen during the treatment period.
The authors rightly urge caution in interpretation of the finds in this subgroup, but they do venture a suggestion that this TCM pattern can be associated with insomnia and nutrient malabsorption, and acupuncture may have more prolonged action in both of these domains.
On a more positive note, donepezil-related side-effects were reduced from 16% in the sham group to 6% in the real acupuncture group, although this alone does not really justify the 42 treatment sessions.
References
1 Kong X, Han R, Fan X, et al. Acupuncture as an adjunct therapy for mild Alzheimer’s disease: A randomized clinical trial. J Alzheimers Dis JAD. 2026;13872877261435880. doi: 10.1177/13872877261435880
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