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Effect of acupuncture treatment on vascular

dementia
Jianchun Yu, Xuezhu Zhang, Cunzhi Liu, Yingchun Meng and Jingxian Han
Gerontological Department, the First Hospital Affiliated to Tianjin University of Traditional Chinese
Medicine, Tianjin 300193, China
Objective: Recent studies have suggested that acupuncture can ameliorate some symptoms
commonly associated with vascular dementia (VaD). The study was carried out to observe the
clinical therapeutic effects for VaD of yi qi tiao xue, fu ben pei yuan acupuncture method
(supplementing vital forcematter and regulating blood, supporting the root and fostering the
source).
Methods: Sixty inpatients with VaD were randomly assigned to the treat group (TG) or control
group (CG). Both the TG and the CG received routine treatment as other inpatients with VaD,
including medication and traditional acupuncture treatment. After that, the TG was given the
treatment of yi qi tiao xue, fu ben pei yuan acupuncture, which included five body acupoints,
namely, tanzhong (CV17), zhongwan (CV12), qihai (CV6), zusanli (ST36) and xuehai (SP10). The
Treatment was performed once daily for 6 weeks. The mini-mental status examination (MMSE),
the revised Hasegawas dementia scale (HDS-R) and activities of daily living (ADL) exam were
carried out before and after the experiment, to evaluate therapeutic effects of the acupuncture
method.
Results: The MMSE, HDS-R and ADL scores were significantly improved in the TG and CG
(p,0.001). But the overall scores of MMSE and HDS-R for the subjects in the TG were notably
higher than those in the CG (p,0.05). Patients in the TG showed remarkable improvement in
memory, orientation, calculation and self-managing ability in daily living after treatment. The
total effective rate was 80.0% in the TG versus 46.7% in the CG, where significant difference
between the two groups exhibited (p,0.05).
Conclusions: These results suggested that yi qi tiao xue, fu ben pei yuan acupuncture method
had significant therapeutic effects and well tolerated in ameliorate the key clinical symptoms of
VaD. [Neurol Res 2006; 28: 97103]
Keywords: Acupuncture; vascular dementia; yi qi tiao xue; fu ben pei yuan acupuncture
method
INTRODUCTION
Vascular dementia (VaD) is the deterioration of cogni-
tive and emotional capabilities, resulting from a
cerebrovascular disease or stroke. The incidence of
new cases of VaD has been reported to range from six to
12 cases per 1000 people over the age of 70 years per
year
1
. In the Canadian Study of Health and Aging,
incidence was reported to be between 2.5 and 3.8 cases
per 1000 people per year in a population aged over
65 years
2
. The incidence rises with age and is similar in
both sexes. Furthermore, VaD is the second most
common cause of dementia after Alzheimers disease,
accounting for 30% of all dementia cases
3
, and the
mean survival rate seems to be even lower in VaD
patients than in Alzheimers disease patients
4
.
The high prevalence of VaD in the aging population
emerges as a major public health problem. Thus, there
is a need for prospective studies to clarify the
pathogenesis of this condition and to provide appro-
priate measures for prevention and treatment of VaD.
Vascular dementia is a chronic condition that is
incurable, however, some of the symptoms commonly
associated with VaD can be treated to help ease the
progression of the disease. Different therapeutic strate-
gies have been introduced to improve or slow down the
effects of VaD, ranging from ginkgo biloba extract
5
,
antiplatelet agents, anticoagulant and the statins
6
to
cholinesterase inhibitors
7
. Some scientists
8
did not
recommend the use of gingko biloba, because it can
increase the risk of bleeding in patients taking vitamin E
and/or warfarin, and its efcacy is limited. Large doses
of antiplatelet agents and anticoagulant may have
unwanted side effects, however, the long-term benets
of cholinesterase inhibitors and statin needs further
study
9
. Acupuncture, a core component of traditional
Chinese medicine, is becoming recognized as an
effective method for treatment for VaD. For patients
with VaD, acupuncture treatment has shown a relief
in VaD symptoms with minimal side effects, and
*Correspondence and reprint requests to: Jingxian Han, Gerontological
Department, the First Hospital Affiliated to Tianjin University of
Traditional Chinese Medicine, Tianjin 300193, China. [hanjingxian6@
hotmail.com] Accepted for publication November 2005.
#
2006 W. S. Maney & Son Ltd Neurological Research, 2006, Volume 28, January 97
10.1179/016164106X91951

http://www.paper.edu.cn
qualitatively, to improve cognitive and emotional
capabilities. Li et al.
10
studied 30 patients with VaD
treated with acupuncture once daily for 2 months.
Patients were subjected to a variety of tests before and
after the treatment. The tests included the determination
of concentrations of thromboxane A2 and 6-keto-PGF1a
in plasma as well as HDS exam for cognitive function.
The researchers found statistically signicant improve-
ments (p,0.01) in the Hasegawas dementia scale
(HDS) score of patients. For example, the HDS score
before the treatment was 14.70 7.33, while it
increased to 17.22 8.46 after two months of
treatment. The concentrations of thromboxane A2 and
6-keto-PGF1a in plasma also improved signicantly
after the acupuncture (p,0.01). Liu et al.
11
pointed out
that acupuncture could signicantly raise the HDS and
FAQ scores of patients with VaD (P,0.001), prolong
the inow time of cerebral blood ow (p,0.05) and
decrease blood coagulability, hematocrit and the
maximum platelet aggregation rate (p,0.05). Schwarz
et al.
12
found that acupuncture could increase both
cerebral oxygen saturation and cerebral blood ow
velocity of patients with VaD. The clinical status and
cognitive function of the patient also improved after
treatment.
yi qi tiao xue, fu ben pei yuan, an acupuncture
method, which was initiated by Professor Jing-xian Han
during long clinical experience, has been proved to be
effective in clinical practice and various animal experi-
ments to delay the progression of VaD. For example,
Wang et al.
13
found yi qi tiao xue, fu ben pei yuan
acupuncture method could reduce the number of errors
and the time of received shock, and prolong the time of
active avoidance response of senescence accelerated
mouse (SAM) P10 in the shuttle-box test. Yu et al.
14
reported that the expression of glutathione transferase S,
HSP86, broblast growth factor (FGF) and NF-kappa-B
p65 subunit four genes relative to oxidation stress
response in SAM P10 was up-regulated compared with
its homologous control SAM R1. Interestingly, the
expression of the four genes in SAM P10 decreased
after treated with yi qi tiao xue, fu ben pei yuan
acupuncture method for 2 weeks. In another paper by
the same authors
15
, this acupuncture method was
applied to the same animal model. The expression of
insulin-like growth factor system, growth hormone
receptor and estrogen receptor was up-regulated after
acupuncture treatment and showed a tendency similar
to that in the control group.
MATERIALS
Subjects
In this study, 60 patients in total with VaD were chosen,
and all of them were inpatients of Acupuncture
Department in the First Hospital Afliated to Tianjin
University of Traditional Chinese Medicine during
December 2002 and September 2003. The participants
received detailed information about the purpose of the
study and the procedure of the treatment. The inclusion
criteria designed to identify patients with VaD was
developed by NINDS/AIREN in 1993. Patients were also
required to have a Hachinski score >7 and a mini-
mental status examination (MMSE) score between 0 to
23 (mildmoderatesevere dementia). Moreover,
patients enrolled in these trials should be 45 years old
and above, and the duration of the disease should be
2 weeks at least.
The subjects were divided by complete randomiza-
tion by drawing with replacement into two groups,
referred to as the treat group (TG) and the control group
(CG). There were no dropouts during the treatment
period. Data on the subjects with respect to general
characteristics were shown in Table 1.
The principal exclusion criteria was the presence of a
systemic or cerebral disease ( pernicious anemia, folate
deciency, hypothyroidism, depressive syndrome, brain
tumor, pre-existing dementia before cerebrovascular
damage, Alzheimers disease, Parkinsons disease,
multiple sclerosis and amyotrophic lateral sclerosis),
Hachinski score ,7, dementias complicated with
severe cardiac, hepatic and renal functional disorder;
concomitant treatment with a neuroleptic or antide-
pressant drug and inability to give informed consent.
Table 1: General characteristics of the subjects in the treat group
and control group before the rst treatment
Characteristic
Treat group
(n530)
Control group
(n530)
Sex
Male
22 23
Female
8 7
Age (mean SD) (year) 66.60 10.53 66.70 10.40
Duration of VaD
(3 months
14 13
3 months1 year
6 7
12 years
5 5
>2 years
5 5
Education (year)
0
4 4
16
4 7
79
16 14
>10
6 5
Severity of dementia
Mild
15 15
Moderate
11 11
Severe
4 4
Location of the lesion
Left-sided lesions
10 11
Right-sided lesions
13 13
Bilateral lesions
7 6
Diagnosis
Infarct dementia
26 25
Homorrhagic dementia
1 2
Mixed dementia
3 2
MMSE score (mean SD)
12.10 5.55 12.23 5.45
ADL score (mean SD)
53.93 16.21 52.90 16.04
All the data in each group were analysed using SPSS10.0, and no
differences were found between the two groups in any of these values
before the first treatment. MMSE, mini-mental status examination;
ADL, activities of daily living exam.
Effect of acupuncture treatment on vascular dementia: J. C. Yu et al.
98 Neurological Research, 2006, Volume 28, January
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Acupuncture treatment
Both the TG and the CG received routine treatment as
other inpatients with VaD, including routine pharma-
cologic and traditional acupuncture treatment. After
that, the TG were given the treatment of yi qi tiao xue,
fu ben pei yuan acupuncture method.
Routine pharmacologic treatment was given to all
subjects in order to reduce the risk of stroke, such as
antiplatelet agents (aspirin or ticlopidine), antihyperten-
sive, diuretics and nimodipine. These medicines should
be taken following the advice of physician and
according to symptoms of each patient.
The CG received traditional acupuncture treatment.
The prescription comprising neiguan (PC6), sanyinjiao
(SP6) and shuigou (GV26) has been proved to be
effective in curing patients with cerebrovascular lesion
and subsequent disabled state (Table 2). One-off sterile
acupuncture needles (Huatuo, Suzhou Medical Instru-
ments Factory, Suzhou, China), with a length of 50 mm
and diameter of 0.250.35 mm, were used in the trial.
Needles were inserted perpendicularly 1525 mm into
PC6; 1525 mm obliquely into SP6 and 815 mm
obliquely into GV26 to evoke needle sensation
(DeQi), described as tension, numbness and often a
radiating sensation from the point of insertion, reecting
activation of musclenerve afferents. After that, the
needles were retained in situ for 30 minutes and
manipulated once again every 10 minutes. Treatment
should be performed once daily for 6 weeks.
Apart from traditional acupuncture treatment, the TG
received the treatment of yi qi tiao xue, fu ben pei
yuan acupuncture method, which includes ve body
acupoints (Table 2), namely, tanzhong (CV17), zhong-
wan (CV12), qihai (CV6), zusanli (ST36) and xuehai
(SP10). Needles were inserted horizontally 15 mm into
CV17; 2540 mm perpendicularly into CV12, CV6 and
ST36; 1525 mm obliquely into SP10. After getting the
needle sensation, these acupoints were stimulated in the
same way as those in traditional acupuncture method.
Treatment was also given once daily for 6 weeks.
Except for the different sites of acupoints, there were
no differences in the treatment procedures between the
TG and CG.
Criteria for evaluating the efficacy
Patients were graded using the MMSE and HDS-R to
measure their cognitive function, including orientation,
memory, attention, calculation, the ability to name an
object, following verbal and written commands and
writing a sentence spontaneously. The examinations
were carried out right before the rst acupuncture
Table 2: Acupuncture points and their anatomical position and innervation
Treatment Points Local innervation Location
Yiqitiaoxue, fubenpeiyuan
acupuncture treatment
CV6 The anterior cutaneous branch
of the eleventh intercostal nerve
On the anterior median line of the
lower abdomen, 4 cm below the umbilicus
CV12 The anterior cutaneous branch
of the eighth intercostal nerve
On the anterior median line of the upper
abdomen, 10 cm above the umbilicus
CV17 The anterior cutaneous branch of
the fourth intercostal nerve
On the anterior median line of the chest,
at the level of the fourth intercostal space,
at the midpoint between the two nipples
SP10 The anterior femoral cutaneous nerve When the knee is flexed, on the medial
aspect of the thigh, the point is 4 cm above
the mediosuperior border of the patella,
on the bulge of the medial portion of m.
quadriceps femoris
ST36 The lateral sural cutaneous nerve and
the cutaneous branch of the
saphenous nerve, deeper, the
deep peroneal nerve
On the anterior aspect of the lower leg,
one fingerbreadth (middle finger) from the
anterior crest of the tibia
traditional acupuncture treatment PC6 The branches of the median nerve On the palmar aspect of the forearm, 5 cm
above the transverse crease of the wrist,
between the tendons of m. palmaris longus
and m. flexor carpi radialis
SP6 The saphenous nerve; deeper, in the
posterior aspect, the tibial nerve
On the medial aspect of the lower leg,
7.5 cm above the medial malleolus,
on the posterior border of the medial
aspect of the tibia
GV26 The buccal branch of the facial nerve,
and the branch of the infraorbital nerve
On the face, at the junction of the superior
one-third and middle one-third of the philtrum
CV, conception vessel; SP, spleen meridian; ST, stomach meridian; PC, pericardium meridian; GV, governor vessel.
Effect of acupuncture treatment on vascular dementia: J. C. Yu et al.
Neurological Research, 2006, Volume 28, January 99
http://www.paper.edu.cn
treatment, just after the last treatment by a physician
who specialises in occupational medicine and have a
long practice in an occupational health service. Both
the patients and examiner were blinded as to which
group the patients belonged to.
On the basis of criteria for the diagnosis, the
differentiation of syndrome and the valuation of efcacy
of vascular dementia for research studies
16
, score
reduction rate (SRR) was chosen as the efcacy index
for evaluating the improvement of cognitive function.
SRR5(score of post-treatment score of pre-treatment)/
score of pre-treatment 6 100%.
Similarly, activities of daily living (ADL) exam was
applied to the patients to evaluate the loss of ability to
perform activities of daily living before and after
treatment. SRR was also selected as the efcacy index
for evaluating the improvement of self-managing ability
in daily living, but in ADL exam, SRR5(score of pre-
treatment score of post-treatment)/score of pre-
treatment 6100%.
In the two formulas above, it was considered to be
markedly effective if SRR>20%, effective if SRR>12%,
ineffective if SRR,12% and aggravated if SRR,212%.
Study design
The study would be last for 6 weeks and all patients
were asked to avoid other treatments during the
intervention period. Two experienced acupuncturists
did acupuncture, one experienced physician gave
standard measurement and a statistician performed the
statistical analysis. All side effects were recorded.
The subjects did not know that some were given a
control treatment, and they were thus blinded to the
kind of treatment they received. The acupuncturists
knew what kind of treatment each subject was given,
and the study was thus single blinded in that respect.
The physician examining the patients and carrying out
the measurements of the MMSE, HDS-R and ADL exams
was unaware of what kind of treatment each subject
received. That part of the study was thus double
blinded. Moreover, the acupuncturists were unaware
of the results of the examination until the treatment had
been completed. The statistician who performed the
analysis was blinded to groups and treatments. Apart
from the difference in points used between the two
groups, all subjects were treated as equally as possible,
in treatment procedure and communication with
acupuncturists. The lack of double blindness in this
study may not be a big problem.
Before and after treatment, all subjects underwent a
global assessment using MMSE, HDS-R and ADL exams.
Enrolled patients demographic data and medical
history were recorded.
Statistical analysis
The results were presented as mean SD or as
individual results unless and otherwise stated explicitly.
Univariate tests of statistical signicance (one- or two-
sided whenever appropriate) were carried out by
Students matched-paired within each group and two-
sample t-tests between TG and CG. The clinical scale
analysis was conducted by rank sum test. The level of
statistical signicance was set at 0.05. Statistical
analyses were carried out using SPSS version 10.0
(SPSS Inc., Chicago, Illinois, USA).
RESULTS
All the patients completed all the treatments according
to the preset time schedule and no adverse effects were
caused by the acupuncture treatment.
Analysis of MMSE score of the two groups between pre-
and post-treatment
Before the rst treatment, the score of MMSE was
12.10 5.55 for the TG and 12.23 5.45 for the CG
(p.0.05). The MMSE score increase to16.23 8.00
and 14.67 6.60 for the TG and CG at the end of
treatment (Table 3). There was signicant change for
either group after acupuncture treatment of 6 weeks
(p,0.001), and the difference between the pre- and
post-treatment for the TG was, therefore, still more
prominent than that for the CG (p,0.05).
Difference of HDS-R score of the two groups between
pre- and post-treatment
There was no difference between the two groups
before the rst treatment (p.0.05). For the TG, the
HDS-R score changed from 11.25 4.49 to 15.30
5.54 during the treatment period. As to CG, the value
was 10.47 4.52 at the beginning, and rose to 13.05
5.67 after 6 weeks treatment (Table 4). Signicant
difference was found between pre- and post-treatment
for each group (p,0.001). Although the HDS-R score
increased for both groups during the treatment period,
the value was systematically higher for the subjects in
the TG than for that in the CG (p,0.05).
Comparison of ADL scores of the two groups between
pre- and post-treatment
The score of ADL for the TG decreased from 53.93
16.21 to 49.17 16.10 during the treatment period
Table 3: Analysis of MMSE score of the two groups between pre- and post-treatment
Pre-treatment Post-treatment Difference between pre- and post-treatment
TG 12.10 5.55 16.23 8.00
{
4.27 2.05*
CG 12.23 5.45 14.67 6.60
{
2.43 1.08
*p,0.05, significant difference between the two group;
{
p,0.001, extremely significant difference between the two groups.
Effect of acupuncture treatment on vascular dementia: J. C. Yu et al.
100 Neurological Research, 2006, Volume 28, January
http://www.paper.edu.cn
(p,0.001). For the CG, the score of ADL was reduced
from 52.90 16.04 to 50.67 16.70. There was
signicant change in activity of daily life for either group
(p,0.001), but no systematic difference was observed
between the two groups (p.0.05).
Improvement on MMSE score at different cognitive
domain of the TG
From Table 5 we can see, yi qi tiao xue, fu ben pei
yuan acupuncture method could signicantly raise the
score of memory, calculations and orientation for TG
after 6 weeks treatment (p,0.05). Especially for the
score of orientation, it was 3.93 1.65 before the rst
treatment and increased markedly to 6.03 2.18 at the
end of the treatment (p,0.001). As to the score of
executive functions and abstract thinking, the values did
not change obviously during the treatment period
(p.0.05).
Relationship between the duration of VaD and curative
effect
In this experiment, the duration of VaD was divided
into four phases, that is, within 3 months, 3 months to
1 year, 12 years and .2 years. To our surprise, there
were not signs of differences in curative effect among
the four phases at the end of the treatment period
(p.0.05), in other words, there was no relationship
between the duration of VaD and efcacy of yi qi tiao
xue, fu ben pei yuan.
Relationship between initial severity of dementia and
therapeutic effect for the TG
The effective rate was 86.7 and 90.9% for mild and
moderate cases in the TG, but for severe subjects, it
decreased sharply to 25.0%. Much greater effect was
observed in the mild and moderate subjects than in the
severe subjects of the TG, and the difference was
statistically signicant (p,0.001). No systematic
differences were noted between the mild and moderate
subjects (p.0.05).
Comparison between therapeutic effect and the onset
times of VaD
The effective rate was 83.3, 80.0 and 75.0% for 1, 2
and >3 times of VaD onset, respectively. No differences
of therapeutic effect were detected for the occurrence
times of VaD, therefore, the efcacy of yi qi tiao xue, fu
ben pei yuan acupuncture method was not correlated
clearly with the onset times of VaD (p.0.05).
Comparison between the two groups in clinical
therapeutic effect
After 6 weeks of treatment, a remarkable greater
efcacy was detected for the patients in the TG than in
the CG. Of the 30 patients enrolled in the TG, 18
patients showed markedly effective and six patients
effective. As for the CG, the number of patients showing
markedly effective and effective was 10 and four
respectively. The overall effective rate was 80.0% in
the TG versus 46.7% in the CG, with signicant
difference between the two groups (p,0.05).
DISCUSSION
Acupuncture is used extensively in oriental medicine
and has emerged as an important modality of com-
plementary and alternative therapy to western medi-
cine
1719
. In clinical studies, acupuncture treatment has
been suggested to be able to relieve VaD symptoms and
improve cerebral blood supply
1012
. The results of our
study suggested that acupuncture may be useful in
relieving symptoms of VaD, and were similar to the
results obtained in studies using actual acupuncture
techniques.
In spite of its long history and public acceptance, an
unequivocal scientic explanation regarding to the
physiological mechanism of acupuncture has not been
found and awaits further investigation. Various animal
data and clinical observations suggested that acupunc-
ture could modulate activities in the central nervous
system and inuence treatment areas via release of
neurotransmitters/hormones or direct modulation of
neural pathway
2024
. Cho et al.
25
proposed that the
central nervous system might be an important mediator
of acupuncture effects. Acupuncture was known to
possess a neuroprotective effect against cerebral ische-
mia in monkeys and gerbils
26,27
. The neuroprotective
effect of acupuncture against ischemic injury may be
due to the opening of K
ATP
channels, prolonging the
period before the membrane depolarization occurs, and
subsequently inhibiting the expression of transcription
Table 5: Improvement on MMSE score at different cognitive
domain for the TG
Pre-treatment Post-treatment
Memory 3.90 1.45 4.67 1.61*
Orientation 3.93 1.65 6.03 2.18
{
Calculation 0.95 0.45 1.60 0.72*
Executive function 2.60 1.28 2.87 1.20
Abstract thinking 0.47 0.22 0.50 0.17
*p,0.05, significant difference between pre- and post-treatment;
{
p,0.001, extremely significant difference between pre- and post-
treatment.
Table 4: Comparison of HDS-R score of the two groups between pre- and post-treatment
Pre-treatment Post-treatment Difference between pre- and post-treatment
TG 11.25 4.49 15.30 5.54
{
4.10 1.15*
CG 10.47 4.52 13.05 5.67
{
2.65 1.24
*p,0.05, significant difference between the two group;
{
p,0.001, extremely significant difference between the two groups.
Effect of acupuncture treatment on vascular dementia: J. C. Yu et al.
Neurological Research, 2006, Volume 28, January 101
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factor proteins which play an important role in signal
transduction of neuronal apoptosis
28,29
. Another possi-
ble mechanism may be that acupuncture treatment
could increase cerebral blood ow and improve
microcirculation
1230
. One of the most impressive
effects of the acupuncture is that acupuncture treatment
could help model rats recover rapidly from the
complications of stroke
31
. In addition, oxidative stress
also plays a role in the brain damage seen in VaD
3234
,
and acupuncture could increase superoxide dismutase
activity in the red blood cells of VaD patients
33,34
.
One of the main difculties in assessing the effec-
tiveness of treatments for vascular or mixed dementia is
the lack of validated instruments. Most currently
available instruments focus on AD, although European
guidelines state that the assessment of antidementia
medicinal products should focus on cognitive function,
as determined by a psychologist
35
. The MMSE is an 11
item test that has been found reliable and valid in
assessing limitations in cognitive function: a lower score
reects more severe impairment. The HDS-R exam,
based on nine simple questions, was tested to evaluate
the level of intelligence or dementia. Both the MMSE
and HDS-R exam were used to access cognitive
dysfunction and were short and easy to score. But the
MMSE was the most commonly used screening test in
clinical practice and research, whereas the HDS-R
exam was usually administered to patients in Chinese
and Japanese articles. The Hachinski score used for the
past 20 years to distinguish the vascular component of
dementia is a composite score based on 12 items
concerning clinical signs and vascular risk factors.
Publication of the NINDS-AIREN criteria for possible
or probable VaD and for mixed dementia has more
clearly dened this group of disorders. Moreover,
behavioral changes are frequent in VaD and are present
regardless of the severity of the cognitive decline. It is
therefore important to assess behavioral as well as
cognitive changes to ensure appropriate treatment. The
ADL exam is widely used in the assessment of ability to
perform activities of daily living. For these reasons, the
present study of the efcacy of yi qi tiao xue, fu ben pei
yuan acupuncture method used three measures, the
MMSE, HDS-R and ADL.
The MMSE, HDS-R and ADL scores were signicantly
improved in the TG and CG (p,0.001). However, a
trend was noted that patients in the TG demonstrated
the greatest improvement in their mean total MMSE and
HDS-R score (p,0.05). There was high and signicant
correlation between the MMSE and HDS-R scores, so
we thought the two tests might be interchangeable for
providing the objective measure of cognitive function.
No statistically signicant difference was found in ADL
score between the two groups. Patients in TG signi-
cantly improved on memory (p,0.05), orientation
(p,0.001) and calculation (p,0.05) in MMSE. In
addition, a much greater efcacy of acupuncture was
found in the mild and moderate affected patients than in
the severe cases of VaD (p,0.001).
As has been done for specic treatments of VaD,
studies quantifying the effects of yi qi tiao xue, fu ben
pei yuan acupuncture method on behavioral distur-
bances and preservation of functional capacities would
be useful.
CONCLUSION
The main nding in this study was that acupuncture
treatment was efcacious and well tolerated in treating
some relative symptoms of VaD, such as impairment of
cognitive function and change of self-managing ability
in daily living. Since it showed such promising results,
the work to lay the groundwork for larger, controlled
investigations to determine how acupuncture combats
VaD should be started in the future.
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