Acupuncture enhances the efficacy of an experimental drug for the treatment of vascular dementia. Researchers compared the efficacy of a nootropic drug as a standalone therapy with a combination of the drug and scalp acupuncture. The results are definitive. The total effective rate for the nootropic drug is 73.3%; however, a combination of acupuncture and the drug produced a 93.3% total effective rate. [1]
MMSE (mini-mental state examination) and Katz ADL (Katz Index of Independence in Activities of Daily Living) scores improved by 20% when acupuncture was added to the treatment regimen. The MMSE measures memory and other cognitive abilities. The Katz ADL measures patient outcomes for bathing, dressing, toileting, transferring, self control of urination and defecation, and eating.
The oral nootropic agent oxiracetam was used for all patients in the study. Nootropic agents are drugs and other substances used to improve cognition, including memory. University of Colorado (Boulder) researchers from the Institute for Behavioral Genetics and the School of Pharmacy confirm that oxiracetam increases spatial and contextual learning by increasing membrane-bound hippocampal PKC (protein kinase C). [2]
Heilongjiang University of Traditional Chinese Medicine researchers conducted a randomized controlled human trial using the MMSE and the Katz ADL for evaluation purposes. There were 90 patients divided into three groups. Patients receiving only oxiracetam had a 73.3% total effective rate. Patients receiving scalp acupuncture plus oxiracetam had an 86.7% total effective rate of improvement. Patients receiving scalp acupuncture with rapid manual acupuncture stimulation plus oxiracetam had a 93.3% total effective rate.
Oxiracetam was administered orally (0.8 g), twice per day, for 4 consecutive weeks. Acupuncture was applied to the following acupoints:
- Baihui (GV20)
- Sishencong (MHN1)
- Taiyang (MHN9)
- Fengchi (GB20)
Upon disinfection, a 0.30 mm x 40 mm filiform acupuncture needle was inserted transverse-obliquely (15° angle) into the scalp acupuncture points. A needle retention time of 50 minutes per acupuncture session was maintained. For patients receiving rapid manual stimulation, the needle was rotated, lifted, and thrusted rapidly after insertion.
Patients were evaluated before and after the treatment course of care. Cognitive ability was evaluated according to the MMSE. Daily functional activity was evaluated according to the ADL test. The treatment efficacy for each patient was categorized into 1 of 3 tiers:
- Significantly effective: >2/3 improvement in MMSE and ADL score
- Effective: 1/3 – 2/3 improvement in MMSE and ADL score
- Not effective: <1/3 improvement in MMSE and ADL score
The total treatment effective rate for each patient group was derived as the percentage of patients that achieved at least an effective treatment efficacy tier. Acupuncture with manual acupuncture techniques plus the nootropic agent produced the greatest positive patient outcomes, a 93.3% total effective rate.
In a related MRI experiment, researchers confirm that acupuncture stimulates brain activity for patients with Alzheimer’s disease. [3] Psychological and clinical examinations were also conducted during the study and confirm the results. The researchers used MRIs and documented that Alzheimer’s disease causes reduced hippocampal connectivity. Upon completion of acupuncture therapy at acupoints LI4 (Hegu) and LV3 (Taichong), hippocampal connectivity increased.
The effects of acupuncture on hippocampal activity are of interest in light of the fact that oxiracetam improves spatial and contextual learning by increasing membrane-bound hippocampal PKC (protein kinase C). Additional research confirms that acupuncture prevents hippocampal cell death by enhancing BDNF (brain-derived neurotrophic factor) neural potentiation and reduces the size of pathological brain plaques in Alzheimer’s disease patients. [4]
Feng et al. note that CREB (cAMP response element-binding protein) and BDNF function in memory storage. Their experiments prove that acupuncture increases levels of both BDNF and CREB when applied to acupoint DU20. [5] Feng et al. add that acupuncture “significantly increases the levels of choline acetyltransferase (ChAT) and restores the expression of choline transporter 1 (CHT1) and vesicular acetylcholine transporter (VAChT).” This indicates that acupuncture regulates brain cholinergic functioning. Feng et al. note that electroacupuncture at DU20 and ST36 “reduces brain damage and related behavioral deficits” by upregulation of tight junction proteins occludin, caludin-5, and ZO-1. They note that this biochemical action preserves the integrity of the blood brain barrier and prevents pathological edema.
In related research, Wuhan University of Science and Technology researchers confirm that acupuncture is beneficial for memory restoration. The researchers determined that acupuncture produces a 90% total effective rate for the treatment of vascular dementia. [6] They combined a protocol of scalp acupuncture with body style acupuncture to achieve the positive patient outcomes.
Acupuncture provides gait benefits along with cognitive benefits. Gang et al. find acupuncture effective for the treatment of gait disorders associated with dementia. These often involve circular hip rotations, foot drag, knee movement reductions, postural stooping, reduced arm swing, shuffling, small steps, broad stance, unsteadiness, or difficulty initiating movement. The researchers demonstrate that the application of Huatuojiaji acupuncture points (L2 – L5) combined with scalp acupuncture (DU20, Sishencong) produces a total effective rate of 90.5% for the improvement of gait disorders associated with dementia. Gang et al. conclude, “The efficacy of treating vascular dementia gait disorder with electro-acupuncture (EA) on EX-B2 [Jiaji] along lumbar vertebra combined with scalp acupuncture was superior to orally administered Duxil.” [7]
References
1. Dai XH, Guo YH, Zhang HW, Zou W. (2013). Therapeutic Observation on the Treatment of Vascular Dementia Majorly with Scalp Acupuncture with Rapid Needling Manipulations. Shanghai Journal of Acupuncture and Moxibustion. 32(9).
2. Fordyce, Diana E., Vanessa J. Clark, Richard Paylor, and Jeanne M. Wehner. "Enhancement of hippocampally-mediated learning and protein kinase C activity by oxiracetam in learning-impaired DBA/2 mice." Brain research 672, no. 1 (1995): 170-176.
3. Wang, Zhiqun, Peipeng Liang, Zhilian Zhao, Ying Han, Haiqing Song, Jianyang Xu, Jie Lu, and Kuncheng Li. "Acupuncture modulates resting state hippocampal functional connectivity in Alzheimer disease." PLoS One 9, no. 3 (2014): e91160.
4. Lin, Ruhui, Jixiang Chen, Xiaojie Li, Jingjie Mao, Yunan Wu, Peiyuan Zhuo, Yinzheng Zhang, Weilin Liu, Jia Huang, Jing Tao, and Li-Dian Chen. "Electroacupuncture at the Baihui acupoint alleviates cognitive impairment and exerts neuroprotective effects by modulating the expression and processing of brain-derived neurotrophic factor in APP/PS1 transgenic mice." Molecular Medicine Reports, 2015. doi:10.3892/mmr.2015.4751. Pg 1611.
5. Feng, Shuwei, Yulan Ren, Shilin Fan, Minyu Wang, Tianxiao Sun, Fang Zeng, Ping Li, and Fanrong Liang. "Discovery of Acupoints and Combinations with Potential to Treat Vascular Dementia: A Data Mining Analysis." Evidence-Based Complementary and Alternative Medicine 501 (2015): 310591.
6. Mao, QJ. (2015). Clinical Observation of Xingnaokaiqiao Acupuncture Combined with Scalp Acupuncture in Treatment of Vascular Dementia. Journal of Hubei University of Chinese Medicine. 17(4).
7. Gang, F. E. N. G. "Observation on efficacy of treating vascular dementia gait disorder with electro-acupuncture (EA) on Jiaji (EX-B2) along lumbar vertebra combined with scalp acupuncture." World Journal of Acupuncture-Moxibustion 24, no. 2 (2014): 1-5.
8. Lewis PR. (2002). MERRTT’s Neurology. Shenyang: Liaoning Science and Technology Press. 6.
