August 4, 2016

expert reaction to acupuncture and mild cognitive impairment

Researchers publishing in the journal Acupuncture in Medicine have conducted a meta-analysis of five trials and report that acupuncture appears to be effective for the treatment of a pre-dementia condition (amnestic mild cognitive impairment) though they caution that the studies in question had low methodological quality.

Dr David Reynolds, Chief Scientific Officer, Alzheimer’s Research UK, said:

“Having mild cognitive impairment doesn’t guarantee that someone will go on to develop dementia, but we know that it puts people at a higher risk. With current treatments for memory loss and dementia being so limited, it is important that researchers explore a range approaches that could help people to live better with the symptoms they’re experiencing. Research that combines data from multiple studies often helps to produce the clearest overview of whether an intervention is working, but these analyses are only ever as good as the research on which they are based. In this case there is good reason to be concerned about the quality of some of the original data, which makes it very difficult to draw firm conclusions on the potential benefits of acupuncture for people with early memory problems.

“Anyone who is worried that they might be experiencing memory problems should speak to their GP. Healthcare professionals are best placed to determine whether there is any cause for concern and make sure the most appropriate sources of help and support are available.”

Dr James Pickett, Head of Research, Alzheimer’s Society, said:

“This research does not present new evidence; it summarises a number of pre-existing studies that the researchers themselves highlight were poor quality. The studies involved people with mild-cognitive impairment, which does not always lead to dementia.

“The lack of strong and convincing evidence makes it difficult to reach any meaningful conclusions. On this basis, acupuncture is not the answer to preventing memory problems or dementia.”

Prof. Martin Rossor, Professor of Clinical Neurology, NIHR National Director for Dementia Research, UCLH, said:

“Unfortunately the studies were not well performed and in particular the acupuncture was not blinded and so participants were aware of the intervention. This does not exclude an effect of acupuncture on memory but there is nothing here to recommend its use in mild cognitive impairment (MCI).”

Prof. Edzard Ernst, Emeritus Professor of Complementary Medicine, University of Exeter, said:

“This is a perfect example of the ‘rubbish in, rubbish out’ phenomenon which is well-known to authors of systematic reviews: if the primary studies are flawed, the review of such studies will be flawed as well. The authors of the review acknowledge several shortcomings, like the lack of control of placebo-effects, the paucity of trials and their poor design.

“My biggest concern is that all the trials analysed here originate from China. It has been shown repeatedly that Chinese acupuncture trials almost never report negative results. This means that, in the hands of Chinese researchers, acupuncture works for everything. For anyone who is able to think critically, this means that their data have to be taken with more than just a pinch of salt.

“In other words, the findings of this review are next to meaningless, in my view.”

Dr Elizabeth Coulthard, Consultant Senior Lecturer in Dementia Neurology, University of Bristol, said:

“The authors point out that these results should be interpreted with caution due to potential confounds. It would be extremely difficult to carry out a blinded study into acupuncture; the patient and researcher will both know whether or not the acupuncture has been carried out. So this work is all subject to the placebo effect. One further difficulty is that Mild Cognitive Impairment (MCI) describes people with a range of problems; some people with MCI will go on to get dementia, but others will remain stable or even improve, perhaps because their cognitive symptoms are caused by stress or a reversible medical problem. So any benefit for people with MCI could be related to stress-reduction, rather than a true effect on dementia-related changes in the brain. Overall, this meta-analysis cannot be used to recommend acupuncture in MCI.”

Prof. Robert Howard, Professor of Old Age Psychiatry and Psychopathology, King’s College London’s Institute of Psychiatry, Psychology & Neuroscience, said:

“I am highly sceptical about the claims made that acupuncture may help mild cognitive impairment (MCI). The evidence that acupuncture has any more than a placebo effect just isn’t there for any area of medicine. The admission by the authors that the methodological quality of the included/reviewed studies was poor says it all. This is really no more than a placebo effect. In the absence of proper double-blind, placebo-controlled trials, I would regard this as pretty much unhelpful data.

“This paper does not indicate any real benefit to people with MCI or dementia, at least demonstrated with the kind of stringency that should convince patients, their families or healthcare providers to take it seriously.

“Those of us trying to find and evaluate interventions that might really make a difference in MCI or dementia just tear our hair out when patients and their families hear or read about these kind of studies and their unsubstantiated claims. I know I will hear on the radio or read in the paper that “Acupuncture reverses dementia (or pre-dementia)” and it is so irresponsible and misleading.”

‘Acupuncture for amnestic mild cognitive impairment: a meta-analysis of randomised controlled trials’ by Deng and Wang published in Acupuncture in Medicine on Thursday 4^th August. 

Declared interests

Dr Reynolds: “No conflicts”

Dr Pickett: “No declarations”

Prof. Rossor: “No conflicts of interest”

Prof. Ernst: “I have no conflicts of interest. I have been active in acupuncture research since 25 years and published about 200 articles on the subject.”

Dr Coulthard: “No interests”

Prof. Howard: “No conflicts of interest”