From bench to bedside: current evidence and prospects for acupuncture in managing perioperative neurocognitive...

Perioperative neurocognitive disorders (PND), comprising postoperative delirium and postoperative cognitive dysfunction, represent prevalent complications during the perioperative period, particularly among elderly patients. PND not only impedes patient recovery but also imposes a substantial socioeconomic burden. Consequently, effective prevention and management of PND across the preoperative, intraoperative, and postoperative phases hold significant clinical and public health importance. However, existing clinical interventions remain limited in efficacy, posing ongoing challenges in PND care. Through a comprehensive literature review, this study examines the potential of acupuncture, as a clinical intervention for PND. We synthesize current evidence on acupuncture's diversified protocols, mechanistic framework, and clinical value in PND prevention. We propose that these perioperative risk factors, including anxiety, pain, sleep disruption, inflammation, and thermoregulatory disturbance, do not act in isolation; rather, they may interact through shared pathways to collectively contribute to PND risk. Acupuncture, particularly electroacupuncture and transcutaneous acupoint stimulation, counteracts this network through multi-target regulation centered on the gut-brain axis: it modulates gut microbiota and metabolites, balances key neural circuits, maintains neurochemical and synaptic homeostasis, and simultaneously intercepts multiple risk pathways. By integrating these actions across peripheral and central systems, acupuncture constructs a coordinated neuroprotective network that reduces PND incidence and accelerates cognitive recovery. This review provides a theoretical basis for optimizing perioperative management strategies and guiding mechanistic research on acupuncture-based neuroprotection.