Efficacy and Safety of Acupuncture for Cerebral Small Vessel Disease-Related Cognitive Impairment: A Systematic Review and Meta-Analysis

Introduction Cerebral Small Vessel Disease (CSVD) is a leading cause of vascular cognitive impairment, and CSVD-related cognitive impairment (CSVD-VCI) heavily burdens individuals, families, and society amid population aging. Current CSVD-VCI treatments only control vascular risk factors and manage symptoms. Acupuncture (Traditional Chinese Medicine, TCM) shows potential for improving cognitive function, but its efficacy and safety for CSVD-VCI need systematic verification. This study evaluated acupuncture's efficacy and safety in treating CSVD-VCI via meta-analysis of randomized controlled trials (RCTs), providing clinical evidence. Methods Seven databases (CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library) were searched from inception to September 1, 2024, for RCTs comparing acupuncture (alone/combined with conventional therapy) vs. non-acupuncture for CSVD-VCI. Two reviewers screened literature, extracted data, and assessed bias using Cochrane Risk of Bias Tool. Meta-analyses were done with RevMan 5.4. Outcomes included MMSE, MoCA, ADL scores, ERP-P300 (latency/amplitude), total effective rate, and adverse events. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) were employed to assess evidence reliability and certainty. Results 13 RCTs (916 participants) were included. Acupuncture significantly improved MoCA (MD=2.68, 95%CI 1.41-3.95, P<0.001), MMSE (MD=2.71, 95%CI 1.74-3.67, P<0.001), ADL (MD=0.98, 95%CI 0.34-1.61, P=0.003), shortened ERP-P300 latency (MD=-14.67, 95%CI -19.54 to -9.80, P<0.001), and increased total effective rate (RR=1.28, 95%CI 1.16-1.41, P<0.001). No differences were found in ERP-P300 amplitude (MD=0.78, 95%CI -0.34-1.89, P=0.17) or adverse events (RR=1.50, 95%CI 0.26-8.66, P=0.65). Short/medium-term (4/8 weeks) acupuncture had consistent efficacy; long-term (≥12 weeks) efficacy was non-significant (few studies, poor compliance). No publication bias (MMSE funnel plot); results were robust (sensitivity analysis). GRADE assessment indicated moderate to very low evidence certainty across outcomes. Conclusions Acupuncture effectively improves cognitive function and daily living abilities in CSVD-VCI patients with good safety. However, due to inconsistent acupuncture protocols, unclear methodology reporting, and lack of long-term follow-up, more high-quality, large-sample RCTs with standardized protocols and long-term follow-up are needed.