Effectiveness of acupuncture combined with donepezil for Alzheimer's disease: A systematic review and meta-analysis

The incidence of Alzheimer's disease (AD) is gradually increasing in an aging society, imposing a heavy burden on society. Current studies have found that acupuncture therapy combined with donepezil has a good clinical effect in treating AD. We plan to conduct a systematic review and meta-analysis to evaluate the effectiveness of acupuncture combined with donepezil in AD patients.

Eight databases were searched for randomized controlled trials (RCTs) using acupuncture in combination with donepezil for the treatment of AD, from the establishment of the database to October 1st, 2023. The clinical efficacy rate, Mini-Mental State Examination, AD Assessment Scale for Cognitive Capacity, Skill Level on Activities of Daily Living, Montreal Cognitive Assessment, Behavioral Pathology in AD Rating Scale, and adverse events were mainly used to evaluate the outcomes. RevMan 5.4.1 software was used to evaluate the quality of the included studies and perform a meta-analysis.

A total of 12 RCTs were included. Meta-analysis showed that acupuncture combined with donepezil seemed to be more effective than donepezil monotherapy for treatment of AD in improving the clinical efficacy rate (relative risk = 1.35; 95% confidence interval [CI]: 1.17-1.56; Z = 4.10; P < .0001), the Mini-Mental State Examination score (mean difference [MD] = 3.28; 95% CI: 1.81-4.75; Z = 4.37; P < .0001), and the Montreal Cognitive Assessment score (MD = 6.04; 95% CI: 4.76-7.32; Z = 9.23; P = .00001), while reducing the AD Assessment Scale for Cognitive Capacity score (MD = -3.57; 95% CI: -3.94 to -3.20; Z = 18.91; P < .00001), the Skill Level on Activities of Daily Living score (MD = -2.52; 95% CI: -4.05 to -0.99; Z = 3.23; P = .001), and the Behavioral Pathology in AD Rating Scale score (MD = -4.04; 95% CI: -4.58 to -3.50; Z = 14.64; P < .00001).

Acupuncture combined with donepezil is an effective treatment which can improve cognitive ability and quality of life for AD patients. However, it is imperative to conduct more large-scale and high-quality RCTs in order to establish more definitive conclusions regarding this therapeutic approach in the future.