Acupuncture for vascular dementia: an overview of systematic reviews and meta-analysis

Abstract

To systematically synthesize evidence from systematic reviews (SRs) and meta-analyses (MAs) regarding the efficacy and safety of acupuncture for vascular dementia (VD), evaluate the methodological and evidence quality, and characterize commonly used acupoint selection patterns through data mining. Eight databases were searched from inception to October 2025. SRs/MAs of randomized controlled trials (RCTs) on acupuncture for VD were included. Methodological quality, completeness of reporting, and certainty of evidence were assessed using AMSTAR-2, PRISMA 2020, and GRADE, respectively. Furthermore, a secondary data mining analysis was conducted on primary RCTs to identify meridian and acupoint selection laws. Sixteen SRs/MAs were included. According to AMSTAR-2, only one review was of high quality, while 87.5% were rated low or critically low, primarily due to the lack of protocol registration. GRADE assessment indicated that 97.9% of outcomes were of low or very low certainty, mainly downgraded for risk of bias and imprecision. Most pooled estimates favored acupuncture for cognitive and functional outcomes, but certainty of evidence was predominantly low or very low according to GRADE criteria. A frequency analysis of the 242 unique RCTs identified the Governor Vessel (18.8% of meridian usage) and the acupoints GV20 (Baihui), EX-HN1 (Sishencong), and ST36 (Zusanli) among the most commonly used points; these patterns should be considered hypothesis-generating rather than validated treatment recommendations. Current evidence indicates potential signals of benefit for acupuncture in VD, but findings remain inconclusive owing to prevalent methodological flaws and high heterogeneity in the primary trials. Future research should prioritize rigorous, large-scale, sham-controlled RCTs testing standardized candidate protocols to establish definitive evidence. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251180848 , identifier CRD420251180848.