Comparisons of acupuncture therapies combining conventional treatment in the management of vascular cognitive impairment: a systematic review and network meta-analysis

Background Vascular cognitive impairment (VCI) is the second most frequent form of cognitive disorder. It is mainly caused by a diseased cerebral vasculature and affects patients’ cognition and activities of daily living (ADL). Previous studies have demonstrated that acupuncture therapy is a promising complementary treatment that significantly improves cognitive status and ADL in VCI patients. This study aimed to investigate the effects of different types of acupuncture therapies and conventional treatments on cognitive status and ADL in VCI patients to provide evidence-based clinical recommendations. Methods We searched seven electronic databases for randomized controlled trials comparing acupuncture therapies [including manual acupuncture (MA), scalp acupuncture (SA), electroacupuncture (EA), and auricular acupuncture (AA)] with conventional treatment [pharmacotherapy (P), cognitive rehabilitation (CR)] or standard care (SC) in patients with VCI. The primary outcome was cognitive improvement, while secondary outcomes included improvement in ADL and the risk of severe adverse effects. A frequentist random-effects network meta-analysis was performed under a consistency model. Study quality was assessed using the RoB 2.0 tool. Inconsistency was examined via node-splitting. Subgroup analysis, meta-regression, and sensitivity analysis were conducted to explore heterogeneity and assess robustness. Publication bias was evaluated using funnel plots and Egger’s test. Results Through stepwise exclusion of studies contributing to publication bias and inconsistency, a robust bias-adjusted network meta-analysis dataset was established. The results showed that among all interventions, SA+P+SC demonstrated the greatest efficacy in improving cognitive status compared to SC (SMD: 2.04; 95% CI: 1.21–2.86) with substantial heterogeneity (I 2 = 71.0%), no significant inconsistency, and relative low publication bias ( p = 0.7020). Conclusion Acupuncture, particularly SA combined with P and SC, appears to be a safe and effective adjunctive treatment for patients with VCI. Future studies are warranted to establish VCI-specific MCID thresholds and to validate these findings through large-scale, high-quality RCTs. Systematic review registration https://inplasy.com/inplasy-2023-5-0114/ , identifier INPLASY202350114.