Effects of acupuncture on cognitive function and lipid metabolism in post-stroke vascular dementia: a systematic review and meta-analysis of randomized controlled trials

Post-stroke vascular dementia (PSVD) is a prevalent cognitive disorder and an underexplored area in dementia research, yet conventional pharmacotherapies have limited efficacy. Although acupuncture has emerged as a promising non-pharmacological intervention, no systematic review has specifically evaluated its effects in PSVD. This meta-analysis therefore aimed to assess the efficacy, safety, and potential treatment parameters of acupuncture for PSVD.

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, seven databases were searched for randomized controlled trials (RCTs) investigating acupuncture for PSVD from inception to November 3, 2025. Included studies were assessed for risk of bias using the Cochrane Risk-of-Bias 2.0 tool, and meta-analyses were conducted in Stata to evaluate outcomes and explore sources of heterogeneity. The main pooled analyses included both add-on trials and monotherapy trials, which addressed distinct clinical questions and were therefore interpreted cautiously.

Thirteen RCTs involving 1,085 patients were included. Acupuncture was associated with a higher study-defined overall effective rate, a non-standardized and heterogeneous outcome [relative risk = 1.27, 95% confidence interval (CI): 1.17-1.37, p < 0.001], as well as improvements in Mini-Mental State Examination (MMSE) scores [mean difference (MD) = 2.89, 95% CI: 2.15-3.64, p < 0.001] and Montreal Cognitive Assessment (MoCA) scores (MD = 2.80, 95% CI: 2.33-3.28, p < 0.001). An exploratory subgroup analysis suggested a larger MMSE effect in trials with 12 weeks of treatment (MD = 4.20). However, because this analysis was not prespecified and the number of studies in each subgroup was limited, this finding should be interpreted as hypothesis-generating. Acupuncture was also associated with lower total cholesterol [standardized mean difference (SMD) = -0.574, p = 0.002] and triglyceride levels (SMD = -0.552, p = 0.002), although these lipid-related findings were based on only two studies and should be regarded as exploratory. Only three minor adverse events (scalp hematomas) were reported; however, adverse-event reporting was incomplete across the included studies. No strong signal of publication bias was detected for MMSE.

Overall, acupuncture-related interventions may be associated with cognitive improvement in PSVD, but the certainty of evidence remains limited by methodological weaknesses, incomplete safety reporting, and the exploratory nature of the study-defined overall effective rate, lipid-related outcomes, and treatment-duration findings. Larger, high-quality multicenter RCTs are needed to confirm these observations.

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251246224, identifier CRD420251246224.