The Effectiveness and Safety of Chemical Drugs Combined with Acupuncture for Alzheimer's Disease: A Systematic Review and Meta-Analysis

Introduction: Acupuncture has been applied with chemical drugs to treat Alzheimer's disease (AD) in the clinic. Whether such combination is effective and safe should be studied although it is recommended by some researchers. Methods: To explore the effectiveness and safety of acupuncture combined with chemical drugs for AD, databases like PubMed, Web of Science were searched to retrieve randomized controlled trials (RCTs) on AD treated with acupuncture and chemical drugs to perform meta-analysis. The risk of bias in each study was assessed using the Cochrane risk of bias tool. Meta- analysis was performed using RevMan 5.3. Results: Five studies were included in which only donepezil combined with acupuncture was evaluated. Acupuncture combined with donepezil showed a significant difference in effectiveness rate [RR=1.45, 95% CI (1.19, 1.77), P =0.0002] compared with donepezil. On the comparison of mini-mental state examination (MMSE) score and Alzheimer's disease assessment scale cognitive subscale (ADAS-Cog) score there was no difference. However, after one trial with severe AD patients was removed, acupuncture combined with donepezil showed better effect than donepezil alone. Conclusion: Acupuncture combined with donepezil could work on AD at the early stage or being mild, implying that acupuncture could be a complementary therapy for AD at the early stage or being mild. Besides, scalp acupuncture seems to be more effective on improving cognitive function. However, this conclusion must be considered cautiously, given the small sample size and lack of trials with high quality. Therefore, more high-quality, multicenter, prospective RCTs with large sample sizes are needed to further clarify the effect of acupuncture combined with chemical drugs for AD.