“Silent cerebrovascular lesions” occur among elderly “normal” volunteers besides patients with previous symptomatic strokes

Acupuncture for vascular dementia

BACKGROUND

Dementia is a widespread condition characterized by acquired global impairment of intellect, memory and personality, but with no impairment of consciousness. There is no definitive medical or surgical treatment for vascular dementia. Acupuncture is an ancient Chinese method which has been used for both the prevention and treatment of diseases for over three thousand years. Preliminary searches revealed more than 105 studies of acupuncture for treating vascular dementia. Benefit was reported in up to 70-91% of the treatment group. Body acupuncture and electroacupuncture were the most commonly used techniques. A comparison of electroacupuncture and acupuncture therapy alone suggested that the former was more effective in promoting the recovery of cognitive function.

OBJECTIVES

The objective is to assess the efficacy and possible adverse effects of acupuncture therapy for treating vascular dementia.

SEARCH STRATEGY

The trials were identified from a search of the Cochrane Dementia and Cognitive Improvement group's Specialized Register on 2 February 2007 which contains records from all major health care databases and many ongoing trials databases. In addition the Allied and Complementary Medicine Database was searched and the web was searched using the search engine Copernic.

SELECTION CRITERIA

Randomized controlled trials testing acupuncture therapy in the treatment of vascular dementia were included regardless of language and publication types. The intervention and control group had to receive identical treatment apart from the acupuncture intervention. In view of possible confounding, studies in which acupuncture was combined with other treatments were subjected to subgroup analyses.

DATA COLLECTION AND ANALYSIS

Titles and abstracts identified from the searches were checked by two reviewers. If it was clear that the study did not refer to a randomized controlled trial in vascular dementia, it was excluded. If it was not clear from the abstract and title, then the full text of study was obtained for an independent assessment by two reviewers. The outcomes measured in clinical trials of dementia and cognitive impairment often arise from ordinal rating scales. Summary statistics were required for each rating scale at each assessment time for each treatment group in each trial for change from baseline.

MAIN RESULTS

In the absence of any suitable randomised placebo-controlled trials in this area, we were unable to perform a meta-analysis.

AUTHORS' CONCLUSIONS

The effectiveness of acupuncture for vascular dementia is uncertain. More evidence is required to show that vascular dementia can be treated effectively by acupuncture. There are no RCTs and high quality trials are few. Randomised double-blind placebo controlled trials are urgently needed.

Vascular dementia: a contemporary review of epidemiology, diagnosis, prevention, and treatment

The past decade has seen a renewed interest in vascular dementia. Key epidemiologic studies have examined the prevalence, incidence, course and risk factors of vascular dementia. New classification systems have been developed to improve the reliability of the diagnosis, and there have been advances in diagnostic methodology, such as neuroimaging and neuropsychological assessment. New treatments for vascular dementia are being developed to protect the brain from cerebral ischemia and to limit progression of cognitive impairment. Diagnostic criteria for vascular dementia remain to be validated by carefully designed, systematic, clinicopathologic study. Once such criteria are validated, meaningful study of subgroups of vascular dementia can be explored. Until the relationship between vascular dementia and Alzheimer's disease is better defined, the nosology for vascular dementia may be defined best as dementia associated with stroke.

Status of risk factors for dementia associated with stroke

BACKGROUND

Cognitive impairment associated with vascular disease may be the only preventable form of dementia of late life. Identification of risk factors for dementia associated with stroke may be a prelude to improved intervention.

SUMMARY OF REVIEW

I reviewed putative risk factors for dementia associated with stroke. These included demographic, atherogenic, stroke-related, and genetic factors. Key studies from the English literature were reviewed and graded according to quality of evidence ratings (classes I, II, and III). Although many of the cardiovascular disease risk factors are logical antecedents of dementia associated with stroke, age was the only factor that could be considered a well-documented risk factor.

CONCLUSIONS

We should continue to support efforts directed at primary stroke prevention and the brain-at-risk and predementia stages. Additional rigorous epidemiological study is needed to clarify risk factors for dementia associated with stroke.