Efficacy and Safety of Acupuncture for Cerebral Small Vessel Disease-Related Vascular Cognitive Impairment: A Systematic Review and Meta-Analysis

Abstract – Introduction: Cerebral small vessel disease (CSVD) is a leading cause of vascular cognitive impairment (VCI), and CSVD-related VCI (CSVD-VCI) heavily burdens individuals, families, and society amid population aging. Current CSVD-VCI treatments only control vascular risk factors and manage symptoms. Acupuncture (traditional Chinese medicine) shows potential for improving cognitive function, but its efficacy and safety for CSVD-VCI need systematic verification. This study evaluated acupuncture’s efficacy and safety in treating CSVD-VCI via meta-analysis of randomized controlled trials (RCTs), providing clinical evidence. Methods: Seven databases (CNKI, Wanfang, VIP, SinoMed, PubMed, Embase, Cochrane Library) were searched from inception to September 1, 2024, for RCTs comparing acupuncture (alone/combined with conventional therapy) vs. non-acupuncture for CSVD-VCI. Two reviewers screened literature, extracted data, and assessed bias using Cochrane Risk of Bias Tool. Meta-analyses were done with RevMan 5.4. Outcomes included Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Activities of Daily Living (ADL) scores, event-related potential (ERP)-P300 (latency/amplitude), total effective rate, and adverse events. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) were employed to assess evidence reliability and certainty. Results: A total of 13 RCTs (916 participants) were included. Acupuncture significantly improved MoCA (mean difference [MD] = 2.68, 95% CI: 1.41 to 3.95, p < 0.001), MMSE (MD = 2.71, 95% CI: 1.74 to 3.67, p < 0.001), ADL (MD = 0.98, 95% CI: 0.34 to 1.61, p = 0.003), shortened ERP-P300 latency (MD = −14.67, 95% CI: −19.54 to −9.80, p < 0.001), and increased total effective rate (RR = 1.28, 95% CI: 1.16 to 1.41, p < 0.001). No differences were found in ERP-P300 amplitude (MD = 0.78, 95% CI: −0.34 to 1.89, p = 0.17) or adverse events (RR = 1.50, 95% CI: 0.26 to 8.66, p = 0.65). Short/medium-term (4/8 weeks) acupuncture had consistent efficacy; long-term (≥12 weeks) efficacy was non-significant (few studies, poor compliance). No publication bias (MMSE funnel plot); results were robust (sensitivity analysis). GRADE assessment indicated moderate to very low evidence certainty across outcomes. Conclusions: Acupuncture effectively improves cognitive function and daily living abilities in CSVD-VCI patients with good safety. However, due to inconsistent acupuncture protocols, unclear methodology reporting, and lack of long-term follow-up, more high-quality, large-sample RCTs with standardized protocols and long-term follow-up are needed.