Review Article

Efficacy and Safety of Auricular Acupuncture for Cognitive Impairment and Dementia: A Systematic Review

Table 1

Characteristics of included studies.

Study IDSample size (included 
→analyzed)
Mean age 
(range, years)/Sex (M : F)
Population(A) Experimental intervention(B) Control interventionOutcomesResults ( value)Adverse events

AA vs WM

Chen et al. 2009 [22]180 (90 : 90) 
→163 (84 : 79)
(A) 70.41 ± 7.32 (58–82)/48 : 36 
(B) 71.56 ± 6.27 (62–84)/40 : 39
Dementia (DSM-IV-R) 
VD (NINDS-AIREN) 
History of stroke 
More than 3 months continued dementia 
MMSE 12–24 
HIS ≥ 7 
CSDD < 8
AAWM (Nimodipin 30 mg tid) (1) MMSE 
(2) ADL
(1) N.S 
(2) N.S
(B) mild dizziness 1, diarrhea 1
Kuang et al. 2012 [23]234 (78 : 78 : 78) 
→234 (78 : 78 : 78)
NR/NRVD (DSM-IV-R)(A1) AA 
(A2) AA + Moxa
WM (Almitrine-Raubasine tablets 1T bid) (1) TCM symptoms 
(2) Clinical efficacy rate (TCM symptoms) 
(3) MMSE 
(4) HDS
(1) (A1) < , (A2) <
(2) (A1) > , (A2) > , (A2) >
(3) (A1) > , (A2) > , (A2) >
(4) (A1) > , (A2) >
None
Shi 2011 [24]126 (42 : 42 : 42) 
→126 (42 : 42 : 42)
(A1) 67.90 ± 6.20 (NR)/27 : 15 
(A2) 68.92 ± 6.11 (NR)/28 : 14 
(B) 69.12 ± 5.66 (NR)/30 : 12
VD (NINDS-AIREN)(A1) AA 
(A2) AA + Moxa
WM (Almitrine-Raubasine tablets 1T bid) (1) MMSE 
(2) ADL 
(3) HDS 
(4) Clinical efficacy rate (TCM guideline on treatment of senile dementia)
(1) (A2) > , (A2) >
(2) (A2) > , (A2) >
(3) (A2) > , (A2) >
(4) (A2) > , (A2) > , (A1) >
None

AA + WM vs WM

Ai 2013 [25]60 (30 : 30) 
→60 (30 : 30)
NR (41–68)/32 : 28VD (DSM-IV)AA + (B)WM (Piracetam 0.8 g 1T tid)Clinical efficacy rate (dementia symptoms)(A) > NR
Liu 2016 [26]93 (33 : 29 : 31) 
→90 (31 : 28 : 31)
(A) 71.23 ± 9.08 (60–90)/16 : 15 
(B1) 71.57 ± 7.53 (60–88)/12 : 16 
(B2) 71.13 ± 8.90 (61–91)/13 : 18
MCI 
MMSE > 17 (illiteracy), >20 (primary school group), >24 (middle school and above group) 
MoCA < 26
AA + (B1)(B1) WM (Cinnarizine 25 mg tid, Methylcobalamin 0.5 mg qd, Piracetam 0.8 g tid, Salvia tablets 2T tid) 
(B2) Wait-list
(1) MMSE 
(2) MoCA
(1) at 12 months: (A) > , (B1) > /at 1, 3, 6 months: N.S 
(2) at 12 months: (A) > /at 1, 3, 6 months: N.S
None
Rodríguez-Mansilla et al. 2015 [27]120 (40 : 40 : 40) 
→111 (40 : 35 : 36)
(A) 85.4 ± 5.9 (NR)/6 : 34 
(B1) 85.8 ± 4.9 (NR)/9 : 26 
(B2) 81.9 ± 5.9 (NR)/10 : 26
Elderly (>65 years) 
Dementia (DSM-IV) 
MMSE 0–20
AA + (B2)(B1) relaxing massage + (B2) 
(B2) routine care (WM and physiotherapy)
(1) Structured questionnaire ((a) behavior alterations, (b) sleep disturbance, (c) participation in rehabilitation, (d) participation in eating) 
(2) Doloplus-2 scale (change) 
(3) CSDD (change) 
(4) Campbell scale (change)
(1) N.S, but at 2 months of follow-up: (d) (A) >
(2) at 1 month: (A) > /at 2, 3 months, at 1 month of follow-up: (A) > /at 2 months of follow-up: N.S 
(3) at 1, 2, 3 months, at 1 month of follow-up: (A) > /at 2 months of follow-up: N.S 
(4) at 1 month of follow-up: (A) > /at 1, 2, 3 months, at 2 months of follow-up: N.S
NR

AA + HM vs HM

Chen et al. 2013 [28]64 (32 : 32) 
→64 (32 : 32)
72.3 ± 11.6 (NR)/38 : 26Elderly (>65 years) 
MCI (CCMD-2-R) 
MMSE 18–26 
ADL 21–50
AA + HMHM (1) MMSE 
(2) ADL
(1) (A) >
(2) (A) <
None
X. Lu and S. Lu 2008 [29]30 (15 : 15) 
→NR
NR/NR60–75 years 
Dementia (ICD-10) 
MMSE 18–26 
ADL 21–50
AA + HMHM (1) MMSE 
(2) ADL 
(3) Improvement rate (MMSE) 
(4) Improvement rate (ADL)
(1) (A) >
(2) (A) <
(3) (A) >
(4) (A) >
NR
Xiao et al. 2014 [30]90 (30 : 30 : 30) 
→90 (30 : 30 : 30)
(A) 78.32 ± 5.47 (NR)/9 : 21 
(B1) 75.68 ± 4.71 (NR)/10 : 20  
(B2) 76.59 ± 5.08 (NR)/11 : 19
VCIND (criteria of expert consensus)AA + HM(B1) HM 
(B2) WM (Nimodipine 30 mg 1T tid)
(1) MMSE 
(2) MoCA 
(3) Serum 25-hydroxyvitamin D
(1) (A) > , (A) >
(2) (A) > , (A) >
(3) (A) > , (B1) >
NR

AA: auricular acupressure; ADL: activities of daily living; CCMD: Chinese classification of mental disorders; CSDD: Cornell scale for depression in dementia; DSM: diagnostic and statistical manual of mental disorders; HDS: Hierarchic Dementia Scale; HIS: Hachinski Ischemic Scale; HM: herbal medicine; ICD: international classification of diseases; MCI: mild cognitive impairment; MMSE: Mini-Mental State Examination; MoCA: Montreal Cognitive Assessment; NINDS-AIREN: National Institute of Neurological Disorders and Stroke and Association-Internationale pour la Recherché et l'Enseignement Neurosciences; NR: not recorded; TCM: traditional Chinese medicine; VCIND: vascular cognitive impairment, no dementia; VD: vascular dementia; WM: Western medication; ; ; tests were not performed; N.S: not significant between interventions.