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acupuncture:evaluation:neuro-psychiatrie:07. troubles cognitifs post-avc [04 Feb 2025 17:38] Nguyen Johan |
acupuncture:evaluation:neuro-psychiatrie:07. troubles cognitifs post-avc [13 Aug 2025 17:38] (Version actuelle) Nguyen Johan [3. Clinical Practice Guidelines] |
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| + | === Kreiger 2025 === | ||
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| + | Kreiger K, Weiss E, Fluri F. Novel therapies for post-stroke cognitive impairment: a systematic review. Front Neurol. 2025 May 27;16:1569329. https://doi.org/10.3389/fneur.2025.1569329 | ||
| + | ^Backgound| Stroke impacts 15 million people annually, ranking as the second-leading cause of mortality and the third-leading cause of disability globally. Despite advances in acute care, long-term cognitive impairments persist in 30-70% of survivors, impeding rehabilitation and increasing dependency. The existing treatments for post-stroke cognitive impairment (PSCI) show limited efficacy, underscoring the need for more comprehensive approaches. The objective of this systematic review is to evaluate the effectiveness of novel therapeutic interventions for PSCI.| | ||
| + | ^Methods| The present systematic review was conducted in accordance with the PRISMA guidelines and has been registered in PROSPERO (CRD42024621445). A comprehensive search in PubMed and EMBASE identified randomized controlled trials (RCTs) from the past 5 years examining PSCI interventions, with the selection criterion being an assessment of the trials using the Montreal Cognitive Assessment (MoCA). Statistical analyses included pooled mean differences (MD) with 95% confidence intervals (CI), heterogeneity assessment, and subgroup analyses.| | ||
| + | ^Results| Of 755 identified articles, 22 RCTs involving 5,100 participants met the inclusion criteria. The results demonstrated that brain stimulation therapies, particularly transcranial direct current stimulation (tDCS; MD 4.56, 95% CI: 3.19-5.93) and pharmacological interventions (MD 4.00, 95% CI: 3.48-4.52) exhibited significant benefits. **Acupuncture** showed potential benefits (MD 2.65, 95% CI: 1.07-4.23), albeit with considerable variability. Training approaches yielded mixed outcomes (MD 1.53, 95% CI: -0.09-3.15). Early interventions (within 3 months post-stroke) were the most effective.| | ||
| + | ^Discussion|Brain stimulation, especially tDCS, resulted in consistent cognitive benefits, with early initiation enhancing outcomes. Pharmacotherapy demonstrated robust, generalizable results, while cognitive training showed small but reliable effects. **Acupuncture** and physical training hold potential but require further standardization.| | ||
| + | ^Conclusion| Effective stroke rehabilitation requires a multimodal, personalized approach integrating brain stimulation, pharmacotherapy, and cognitive training. Early intervention is critical for maximizing neuroplasticity, the effect of later interventions needs further evaluation. Standardization is needed to optimize physical training and alternative medicine.| | ||
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| + | === Luo 2024 === | ||
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| + | Luo Z, Li W, Jiang J, Sun J, Zhang M, Zhang Y, Dong L, Li K, Wu C. Effect of Acupuncture on Cognitive Function in Patients With Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis. Brain Behav. 2024 Oct;14(10):e70075. https://doi.org/10.1002/brb3.70075 | ||
| + | ^Aims and objective|To investigate the impact of acupuncture on post-stroke cognitive impairment (PSCI).| | ||
| + | ^Backgound| PSCI is a major barrier to stroke patients' rehabilitation, and acupuncture is one of the treatments. However, the benefit of acupuncture on PSCI is unclear.| | ||
| + | ^Design| A meta-analysis and systematic review of randomized controlled trials (RCTs).| | ||
| + | ^Methods| Up to February 1, 2024, databases in PubMed, MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, VIP, and Wanfang Data were searched. The risk of bias was investigated using the Cochrane Handbook for systematic reviews of treatments. Random-effect and fix-effect models were used to report the effects.| | ||
| + | ^Results| There were **29 randomized clinical trials with 2477 participants** included. The findings demonstrated that the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) scores were higher in the acupuncture group than medicine group (mean difference [MD] = 1.74, 95% confidence interval (CI) CI [1.26, 2.23], I2 = 59%, p < 0.01). Compared to medicine group, the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) score exhibited a significant decrease and demonstrated improvement in the acupuncture group. Statistically significant outcomes were observed in the Barthel Index scores and P300 event-related potential (ERP). According to subgroup analysis, acupuncture was superior to conventional therapy for improving cognitive function in PSCI patients at 4 weeks after treatment.| | ||
| + | ^Conclusion| Acupuncture therapy has shown promise in ameliorating cognitive deficits and enhancing daily functional abilities in individuals diagnosed with PSCI. But future research should focus on the duration and implement large sample, high-quality RCTs.| | ||
| + | ^Relevance to clinical practice|Clinical workers in practical clinical work can select appropriate acupoints according to the actual conditions of patients, as well as confirm the treatment course of PSCI patients, while paying attention to observing and evaluating the therapeutic efficacy of acupuncture, to improve the health outcomes of patients in a patient-centered way.| | ||
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| + | === Wu 2024 === | ||
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| + | Wu W, Song C, Yang Y, Hu Y, Lin H. Acupuncture for cognitive impairment after stroke: A systematic review and meta-analysis. Heliyon. 2024 May 1;10(9):e30522. https://doi.org/10.1016/j.heliyon.2024.e30522 | ||
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| + | ^Objective| Acupuncture as an alternative therapy for post-stroke cognitive impairment (PSCI) has emerged as a research focus. The inclusion of additional external treatments in many previous studies prevents a clear, direct assessment of acupuncture's impact on PSCI. In order to prevent patients from developing hypersensitivity to other treatments and misinterpreting acupuncture's true therapeutic value, this study establish stricter intervention criteria and exclude therapies beyond acupuncture. The review aimed to offering a clearer evaluation of acupuncture's efficacy and safety in PSCI treatment.| | ||
| + | ^Methods| This research involved a comprehensive search for randomized controlled trials (RCTs) across eight databases, adhering to the Cochrane Systematic Reviewer's Handbook 5.1.0 for risk-of-bias and quality assessments. A meta-analysis was conducted using RevMan 5.3 software.| | ||
| + | ^Results| The inclusion of **18 publications, totaling 1361 patients**, was achieved. The meta-analysis demonstrated a significantly higher overall efficacy of acupuncture for PSCI compared to controls (OR = 4.06, 95 % CI 2.86-5.76, Z = 7.82). Notable statistical differences were observed in the Montreal Cognitive Assessment scores (MD = 2.32, 95 % CI 1.68-2.97, Z = 7.10) and the Mini-Mental State Examination scores (MD = 2.02, 95 % CI 1.06-2.98, Z = 4.13) between the groups. Improvements in the Barthel Index scores were noted for the experimental group (MD = 5.70, 95 % CI 4.68-6.72, Z = 10.92).| | ||
| + | ^Conclusion| Integrating acupuncture with Western medications offers significant benefits for treating PSCI over Western medications alone. However, the long-term efficacy of acupuncture in PSCI treatment and its potential in reducing recurrence rates remain undetermined. Further high-standard RCTs are essential to explore acupuncture's effectiveness in PSCI treatment more thoroughly. | | ||
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| + | === Yang 2024 === | ||
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| + | Yang G, Guo L, Zhang Y, Li S. Network meta-analysis of non-pharmacological interventions for cognitive impairment after an ischemic stroke. Front Neurol. 2024 Jun 4;15:1327065. https://doi.org/10.3389/fneur.2024.1327065 | ||
| + | ^Objective| This study aims to evaluate the effectiveness of non-pharmacological interventions in improving cognitive function in patients with ischemic stroke through network meta-analysis.| | ||
| + | ^Methods| We searched databases including the Cochrane Library, PubMed, EmBase, and Web of Science for randomized controlled trials (RCTs) on non-pharmacological treatments to improve cognitive impairment following ischemic stroke. The publication date was up to 15 March 2023. Due to the insufficiency of included studies, supplementary searches for high-quality Chinese literature were performed in databases such as CNKI, WanFang Data, and VIP Chinese Science Journals Database. Two reviewers independently went through the literature, extracted data, and assessed the risk of bias in the included studies using the risk of bias assessment tool recommended by the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. By utilizing R 4.2.3 RStudio software and the GeMTC package, a Bayesian network meta-analysis was conducted to assess the improvement in Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores under a variety of non-pharmacological interventions.| | ||
| + | ^Results| A total of **22 RCTs involving 2,111 patients** and 14 different non-pharmacological treatments were included. These interventions were transcranial direct current stimulation (tDCS), reminiscence therapy (RT), remote ischemic conditioning (RIC), physical fitness training (PFT), intensive patient care program (IPCP), moderate-intensity continuous training + high-intensity interval training (MICT + HIIT), medium intensity continuous training (MICT), grip training (GT), acupuncture, cognitive behavioral therapy (CBT), cognitive rehabilitation training (CRT), high pressure oxygen (HPO), moxibustion, and repetitive transcranial magnetic stimulation (rTMS). The results of the network meta-analysis indicated that rTMS had the highest likelihood of being the most effective intervention for improving MMSE and MoCA scores.| | ||
| + | ^Conclusion| The evidence from this study suggests that rTMS holds promise for improving MMSE and MoCA scores in patients with cognitive impairment following ischemic stroke. However, further high-quality research is needed to confirm and validate this finding.| | ||
| === Liu 2023 === | === Liu 2023 === | ||
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| === Comparison of Acupuncture techniques === | === Comparison of Acupuncture techniques === | ||
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| + | == Huo 2024 == | ||
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| + | Huo L, Zhao M, Wang Z, Zhang L, Fu K, Zhang X. A network meta-analysis of different acupuncture therapy in the treatment of poststroke cognitive impairment and dementia. Medicine (Baltimore). 2024 Oct 25;103(43):e40233. https://doi.org/10.1097/MD.0000000000040233 | ||
| + | ^Backgound| Poststroke cognitive impairment and dementia (PSCID) is a major cause of stroke-related morbidities and mortalities. Over the last few years, there has been growing evidence supporting the effectiveness of needle-related treatments in PSCID. Our goal was to rate the included therapies and assess the clinical effectiveness of various needle-related treatments in patients with PSCID.| | ||
| + | ^Methods| We searched PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Chinese Biomedical Literature Service System (SinoMed), Wanfang, FDA.gov, and ClinicalTrials.gov. A mix of subject terms and free words was used to search the databases. The retrieval period was from the inception date of the database to February, 2023. We included SRs and MAs from acupuncture RCTs of patients with PSCID. The Cochrane Risk Assessment Scale was used to evaluate the risk of bias in the included studies. State 17.0 was used for network meta-analysis in accordance with the Bayesian framework.| | ||
| + | ^Results| There were **34 studies total of 2690 patients**. The cumulative ranking curve (SUCRA) revealed that CT + CFT + EA was the most efficient intervention to improve (Mini-Mental State Examination, MMSE) efficiency, followed by CT + CFT + AP to improve (Montreal Cognitive Assessment, MoCA) efficiency, CT + CFT + ACU for improving (Activities of Daily Living scale, ADL) scores, and CT + CFT + EA to improve clinical efficiency.| | ||
| + | ^Conclusion| The results show that Different acupuncture methods can improve cognitive function and daily living ability in patients with PSCID. Network meta-analysis revealed that both CT + CFT + ACU and CT + CFT + EA appeared to be more beneficial for daily living activities, while CT + CFT + EA and CT + CFT + AP appeared to be more helpful for cognitive performance in patients with PSCID. Treatments including acupuncture are safer and have a reduced incidence of negative side effects.| | ||
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| == Liu 2023 == | == Liu 2023 == | ||
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| === Acupoints combination === | === Acupoints combination === | ||
| - | == Comparison of multiple acupoints combination == | + | == Han 2024 (Governor vessel acupuncture) == |
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| + | Han JZ, Yang Y, Wang YF, Feng JH, Song CN, Wu WJ, Lin HB. Effectiveness and safety of Governor vessel acupuncture therapy for post-stroke cognitive impairment: A meta-analysis of randomized controlled trials. Ageing Res Rev. 2024 Aug;99:102355. https://doi.org/10.1016/j.arr.2024.102355 | ||
| + | ^Objective| The purpose of this study was to evaluate the effectiveness of Governor vessel acupuncture (GV Ac) in treating post-stroke cognitive impairment (PSCI).| | ||
| + | ^Methods| There was a total of seven databases examined. Four English databases (Cochrane Library, PubMed, Embase, and Medline) and three Chinese databases (Chinese National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Databases (VIP), and Wan Fang Database) contain all randomized controlled trials (RCTs) comparing Governor vessel acupuncture to other treatments or none acupuncture for PSCI. The exact dates for the search period are from January 1, 2000, to January 1, 2023.Two researchers independently reviewed the literature, gathered RCT data, and performed statistical analysis. All data were analyzed using Review Manager software (Rev Man) 5.3.| | ||
| + | ^Results| This meta-analysis includes a total of **39 trials with 2044 patients**. There were 1022 participants in each of the test and control groups. Following 12-120 days of acupuncture treatment, a meta-analysis revealed that the treatment groups (GV Ac combined with conventional treatment groups) significantly increased their scores on the Curative ratio (OR = 3.00, 95 %CI = 2.37-3.79, P = 0.98, I² = 0 %), Montreal Cognitive Assessment (MoCA)(MD = 1.82, 95 %CI = 1.60-2.03, P = 0.11, I² = 25 %), Mini-Mental State Examination (MMSE)(MD = 2.18, 95 %CI = 1.64-2.72, P<0.005, I² = 92 %), and Activity of Daily Living (ADL)(MD = 5.99, 95 %CI = 5.33-6.64, P = 0.19, I² = 26 %).| | ||
| + | ^Conclusion| The results suggested that acupuncture on points of the Governor vessel enhanced cognitive function in stroke survivors. | | ||
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| - | | ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture | | ||
| - | | ☆☆ | Evidence for effectiveness of acupuncture | | ||
| - | | ☆ |Limited evidence for effectiveness of acupuncture | | ||
| - | | Ø |No evidence or insufficient evidence | | ||
| ==== Brazilian Academy of Neurology (BAN, Brazil) 2022 ⊕ ==== | ==== Brazilian Academy of Neurology (BAN, Brazil) 2022 ⊕ ==== | ||
