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Sommaire
Poststroke Cognitive Impairment
Troubles cognitifs post-AVC : évaluation de l'acupuncture
1. Systematic Reviews and Meta-Analysis
1.1. Generic Acupuncture
1.1.1. Zhang 2015
Zhang Yang, Tang Wei, Song Xiao-Ge, Wu Song, Zhang Gao-Ying, Xu Hua. [Systematical review and meta-analysis of the efficacy of acupuncture and moxibustion plus cognitive rehabilitation training in treating post-stroke cognitive disorder]. Shanghai Journal of Acupuncture & Moxibustion 2015. 34(10):1013-20. (chi). [187058]
| Objective | To systematically assess the efficacy of acupuncture and moxibustion plus cognitive rehabilitation training in treating post-stroke cognitive disorder. |
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| Method | A computer searched CNKI, CBM, VIP, WANFANG DATA, and Pubmed and Cochrane Library for randomized controlled trials (RCT) of acupuncture and moxibustion plus cognitive rehabilitation training for the treatment of post-stroke cognitive disorder. The reference Iiterature in the included literature was also retrieved. Retrieval time limit for both of them was from Jan. 1st 1990 to Jan. 1st 2015. Two reviewers independently selected the trials, extracted the data and assessed the quality of methodology. Meta-analysis was then performed using RevMan 5.3 software. |
| Result | Eleven trials with a total of 789 subjects were finally included. The results of Meta-analysis showed that the following aspects were better in acupuncture plus cognitive rehabilitation training than in cognitive rehabilitation training or medication alone and there were statistically significant differences: the total efficacy rate [RR=1 .58, 95% CI(1.10,2.26), P=0.011, the MMSE sc0re [M.D=2.64, 95% CI(1.78, 3.50), P'0.00001], P300 latency [MD= - 18.46, 95% CI( - 30.51, - 6.41), P=0.003], P300 amplitude [MD=l.23, 95% CI(0.82, 1 .63), P<0.0000 1] and activities of daily living (ADL) [SMD=().52, 95% CI(0.3 1, 0.73), P=0.00001]. Based on the results of a systematical review, the quality of evidence was assessed using GRADE system recommended classification method. The results showed that the level of evidence was low and the strength of recommendations was weak. |
| Conclusion | The results of Meta-analysis showed that the therapeutic effect was better in acupuncture and moxibustion plus cognitive rehabilitation training than in cognitive rehabilitation training or medication alone. Because of low quality of all the original literature, high-quality, multicenter and large-sample randomized blind controlled trials are still needed for validation. |
1.2. Special Acupuncture Techniques
1.2.1. Acupoints combination
1.2.1.1. Hu 2020 (Baihui (GV20) and Shuigou (GV26) Acupoints)
Hu Shuting. [Systematic Review and Meta-analysis of Acupuncture at Baihui (GV20) and Shuigou (GV26) Points Treatment for Post-stroke Cognitive Impairment ]. Journal of Guangzhou University of TCM. 2020. [212895].
| Objective | To systematically evaluate the clinical efficacy of acupuncture at Baihui (GV20) and Shuigou (GV26)points in treating post-stroke cognitive impairment (PSCI). |
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| Methods | The randomized clinical trials (RCTs)regarding acupuncture at Baihui (GV20)and Shuigou (GV26)points treatment for PSCI were searched from China National Knowledge Infrastructure (CNKI), Wanfang database, VIP medicine information system, Chinese Biomedical Database (CBM), PubMed and the Cochrane Library. The quality of methodology in the included literatures was evaluated by Cochrane systematic assessment method, and was given Meta-analysis by Rev Man 5. 3 software. |
| Results | Ultimately, a total of 11 RCTs were included, involving 805 cases. The results of Meta-analysis showed that the experimental group was superior to the control group in the clinical effective rate[OR = 3. 15, 95%CI (1. 81, 5. 46), Z = 4. 08, P < 0. 000 1], improving the Mini-Mental State Examination (MMSE)scores [WMD=2. 21, 95%CI (1. 01, 3. 41), Z = 3. 61, P = 0. 000 3], improving the Montreal Cognitive Assessment (MoCA)scores [WMD = 1. 84, 95% CI (0. 81, 2. 88), Z = 3. 49, P = 0. 000 5]. |
| Conclusion | Acupuncture at Baihui (GV20)and Shuigou (GV26)points is effective for improving the cognitive functions in PSCI patients. However, due to the low quality of the included studies, more high-quality, large-scale and multiple-center RCTs are needed. |
1.2.1.2. Liu 2018 (Baihui (GV 20) and Shenting (GV 24) Acupoints)
Liu Fang, Yao Li-Qun, Chen Jin-Hui. [Therapeutic Efficacy of Acupuncture at Baihui (GV 20) and Shenting (GV 24) for Post-stroke Cognitive Impairment: A Systematic Review]. Shanghai Journal of Acupuncture and Moxibustion. 2018;37(1):104-111. [100878].
| Objective | To evaluate the clinical efficacy of acupuncture at Baihui (GV 20) and Shenting (GV 24) in treating post-stroke cognitive impairment (PSCI) by using the systematic review method. | |
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| Method | Via computer, Chinese Journal Full-text Database, Wanfang, China Biology Medicine disc (CBMdisc),Chinese Science and Technology Periodical Database, Pub Med, Foreign Evidence-Based Medicine(FEMB), the Cochrane Library were retrieved. Chinese Acupuncture and Moxibustion and Shanghai Journal of Acupuncture-moxibustion were manually retrieved. Randomized controlled trials published before Jan 31 st of 2013 on acupuncture at Baihui (GV 20) and Shenting (GV 24) in treating PSCI, both in Chinese and English, were collected. The required data were extracted, then were evaluated according to the criteria of Cochrane systematic review and underwent meta-analysis by using Rev Man 5.0. | |
| Results | Twenty-two clinical trials were finally recruited, including 1 637 subjects. The meta-analysis showed that acupuncture at acupoints including Baihui (GV 20) and Shenting (GV 24) produced a more significant rehabilitation result compared to single rehabilitation training or medication. The comparison of Mini-Mental State Examination(MMSE) score showed: [WMD=3.37, 95%CI(1.70, 5.05), P<0.00001]; the comparison of P300 latency: [WMD=1.22, 95%CI(0.84, 1.59), P<0.00001]. Severe adverse reactions were not discovered. | |
| Conclusion | Acupuncture at Baihui (GV 20) and Shenting (GV 24) can effectively improve the cognitive function of PSCI patients. However, the diagnostic criteria and evaluation indexes are expected to be unified and standardized, and the clinical trials on acupuncture intervening PSCI are required to be further improved methodologically. |
1.2.2. electroacupuncture
1.2.2.1. Zhan 2017
Zhan J, Wang X, Cheng N, Tan F. [Electroacupuncture for post stroke cognitive impairment: a systematic review and Meta-analyses]. Chinese Acupuncture and Moxibustion. 2017;37(10):1119-25. 165857[165857].
| Objective | To systematically evaluate the efficacy and safety of electroacupuncture (EA) for post stroke cognitive impairment (PSCI). |
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| Methods | The randomized clinical trials (RCTs) regarding EA for PSCI published before October of 2016 were researched in China National Knowledge Infrastructure (CNKI), Chinese Biomedical Database (CBM), WanFang database, VIP medicine information system, PubMed and Cochrane Library. The literature screening and information extraction was conducted by two independent reviewers. The quality assessment was performed based on the guidance of the Cochrane Reviewers' Handbook, and Meta-analyses was performed by using RevMan 5. 3 software. |
| Results | Totally 14 RCTs were included, involving 896 PSCI patients. The results of Meta-analyses showed the EA group was superior to the control group in improving the MMSE [MD =1. 78, 95% CI (0. 24, 3. 32), P =0. 02], the MoCA [MD=1. 92, 95% CI (0. 96, 2. 88), P<0. 000 1], P300 latency [MD =-11. 01, 95% CI (-18. 91, -3. 11), P =0. 000 6], P300 amplitude [MD=1. 56, 95% CI (1. 14, 1. 98), P<0. 000 01], FMA score [MD =10. 74, 95% CI (2. 67, 18. 82), P =0. 009] and the clinical effective rate [RR =1. 37, 95% CI (0. 98, 1. 91), P =0. 06]. However, the comparison of BI score in both group had no significant differences [MD =6. 38, 95% CI (-2. 41, 15. 18), P =0. 15]. |
| Conclusion | This Meta-analyses confirmed EA is effective and safe for PSCI, which could improve cognitive function and motor function. However, because of low quality of the included studies, more well-designed multicenter RCTs are needed |
2. Overviews of Systematic Reviews
2.1. Hung 2019
Hung CY, Wu XY, Chung VC, Tang EC, Wu JC, Lau AY. Overview of systematic reviews with meta-analyses on acupuncture in post-stroke cognitive impairment and depression management. Integr Med Res. 2019;8(3):145-159. [199813].
| Background | Acupuncture has been using as an alternative non-pharmacological therapy in the management of post stroke depression and cognitive impairment but its effectiveness and safety remain controversial. We conducted an overview of systematic reviews with meta-analyses to evaluate the evidence on the effect of acupuncture in the treatment of stroke with conventional medicine intervention. |
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| Methods | Systematic reviews summarized the treatment effects of acupuncture for post stroke cognitive impairment and post stroke depression were considered eligible. Methodological quality of included systematic reviews was assessed using A Measurement Tool to Assess systematic Reviews 2 (AMSTAR 2). |
| Results | Four systematic reviews on post stroke cognitive impairment and ten systematic reviews on post stroke depression with good methodological quality were included. Meta-analyses revealed that acupuncture plus cognitive rehabilitation; and acupuncture or moxibustion plus cognitive rehabilitation, versus cognitive rehabilitation demonstrated statistically significant increase in Mini-Mental State Examination scores in compared to cognitive rehabilitation after 4 weeks treatment [Pooled weighted mean difference (WMD) = 3.14, 95% confidence interval (CI) = 2.06 to 4.21, I2 = 36%]; and (Pooled WMD = 3.22, 95% CI = 2.09 to 4.34, I2 = 0%). Furthermore, acupuncture versus antidepressant demonstrated statistically significant improve depression measured by increasing in 17-item Hamilton Depression Rating Scale in comparing to cognitive rehabilitation after 2 weeks treatment (Pooled WMD= -2.34, 95% CI= -3.46 to -1.22, I2 = 5%). Acupuncture usage was not associated with increased risk of adverse events. |
| Conclusions | Acupuncture is safe and improves cognitive function and depressive disorder without obvious serious adverse events for post stroke patients. |
3. Clinical Practice Guidelines
| ☆☆☆ | 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 |
3.1. Canadian Partnership for Stroke Recovery (CPSR, Canada) 2018 ⊕
Evidence-based review of stroke rehabilitation: 18th edition, Canadian Partnership for Stroke Recovery (CPSR). 2018. [197578]. URL/
| Post-Stroke Cognitive Disorders. There is level 1b and level 2 evidence that acupuncture can be an effective intervention in the remediation of cognitive deficits, There is level 1b evidence that acupuncture combined with nimodipine can improve cognitive functioning short term. There is level 1b evidence that electroacupuncture may improve attention, praxis, perception and orientation, but not thinking, organization memory and mental health. |
