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| Les deux révisions précédentes Révision précédente Prochaine révision | Révision précédente | ||
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acupuncture:evaluation:neuro-psychiatrie:07. troubles cognitifs post-avc [04 Feb 2025 17:44] Nguyen Johan [1.2.3.1. Comparison of multiple acupoints combination] |
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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| ==== Generic Acupuncture ==== | ==== Generic Acupuncture ==== | ||
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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.| | ||
| === Luo 2024 === | === Luo 2024 === | ||
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| ^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.| | ^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.| | ||
| + | === 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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| - | | ☆☆☆ | 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 ⊕ ==== | ||
