Skip to main content
Top
Published in: Trials 1/2019

Open Access 01-12-2019 | Acupuncture | Study protocol

Combination of acupuncture and Chinese herbal formula for elderly adults with mild cognitive impairment: protocol for a randomized controlled trial

Authors: Yueqi Chen, Wenjing Zhang, Huangan Wu, Lixing Lao, Jian Xu, Shifen Xu

Published in: Trials | Issue 1/2019

Login to get access

Abstract

Background

Mild cognitive impairment (MCI) is known as a transitional status between normal cognitive function and Alzheimer’s disease (AD). Acupuncture and Chinese herbal medicines (CHMs) are considered to be beneficial to patients with cognitive impairment. However, it is still unknown whether the combination of the two therapies could optimize the therapeutic effect for MCI. This trial is aimed to evaluate the therapeutic effects of acupuncture and the herbal formula Yishen Granule (YSG) for elderly patients with MCI.

Methods/design

This is a multi-sited, patient-blinded, randomized controlled trial (RCT). Two hundred and forty eligible patients will be randomly divided into four groups: A. acupuncture with YSG, B. acupuncture with placebo herbal medicine, C. sham acupuncture with YSG or D. sham acupuncture with placebo herbal medicine. Acupuncture treatment will be given twice a week for 8 weeks and then once a week for 4 weeks. The herbal treatment patients will be given granules daily for 12 weeks, 8 weeks of standard-dose followed by 4 weeks of mid-dose. The primary outcome is scored by the Montreal Cognitive Assessment (MoCA). The secondary outcomes will be scored by the Mini-Mental State Examination (MMSE) and event-related potential (ERP). All the assessments will be conducted at baseline, and at the eighth and 12th week after intervention starts. The follow-up assessments will be performed with the MoCA in the 12th, 24th, and 36th weeks after intervention ends. Intention-to-treat (ITT) analysis will be used in this RCT.

Discussion

This RCT will provide us information on the effect of treating MCI patients with only acupuncture, herbal formula as well as the combination of both. The additive effect or synergistic effect of acupuncture and Chinese herbal formula will then be analyzed.

Trial registration

This trial is registered with ChiCTR-INR-17011569 on 5 June 2017, and has been approved by the Ethics Committee of Shanghai Municipal Hospital of Traditional Chinese Medicine (2017SHL-KY-05).
Appendix
Available only for authorised users
Literature
1.
go back to reference Shim S-M, Song J, Kim J-H, Jeon J-P. Conversion pattern and predictive factor of mild cognitive impairment in elderly Koreans. Arch Gerontol Geriatr. 2016;64:146–50.CrossRef Shim S-M, Song J, Kim J-H, Jeon J-P. Conversion pattern and predictive factor of mild cognitive impairment in elderly Koreans. Arch Gerontol Geriatr. 2016;64:146–50.CrossRef
2.
go back to reference Gentile S. Second-generation antipsychotics in dementia: beyond safety concerns. A clinical, systematic review of efficacy data from randomised controlled trials. Psychopharmacology. 2010;212(2):119–29.CrossRef Gentile S. Second-generation antipsychotics in dementia: beyond safety concerns. A clinical, systematic review of efficacy data from randomised controlled trials. Psychopharmacology. 2010;212(2):119–29.CrossRef
3.
go back to reference Dong M-j, Peng B, Lin X-t, Zhao J, Zhou Y-r, Wang R-h. The prevalence of dementia in the People’s Republic of China: a systematic analysis of 1980-2004 studies. Age Ageing. 2007;36(6):619–24.CrossRef Dong M-j, Peng B, Lin X-t, Zhao J, Zhou Y-r, Wang R-h. The prevalence of dementia in the People’s Republic of China: a systematic analysis of 1980-2004 studies. Age Ageing. 2007;36(6):619–24.CrossRef
4.
go back to reference Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, et al. Mild cognitive impairment—beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med. 2004;256(3):240–6.CrossRef Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, et al. Mild cognitive impairment—beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med. 2004;256(3):240–6.CrossRef
5.
go back to reference Ward A, Arrighi HM, Michels S, Cedarbaum JM. Mild cognitive impairment: disparity of incidence and prevalence estimates. Alzheimers Dement. 2012;8(1):14–21.CrossRef Ward A, Arrighi HM, Michels S, Cedarbaum JM. Mild cognitive impairment: disparity of incidence and prevalence estimates. Alzheimers Dement. 2012;8(1):14–21.CrossRef
6.
go back to reference Juncos-Rabadán O, Pereiro AX, Facal D, Lojo C, Caamaño JA, Sueiro J, et al. Prevalence and correlates of mild cognitive impairment in adults aged over 50 years with subjective cognitive complaints in primary care centers. Geriatr Gerontol Int. 2014;14(3):667–73.CrossRef Juncos-Rabadán O, Pereiro AX, Facal D, Lojo C, Caamaño JA, Sueiro J, et al. Prevalence and correlates of mild cognitive impairment in adults aged over 50 years with subjective cognitive complaints in primary care centers. Geriatr Gerontol Int. 2014;14(3):667–73.CrossRef
7.
go back to reference Wang S, Yang H, Zhang J, Zhang B, Liu T, Gan L, et al. Efficacy and safety assessment of acupuncture and nimodipine to treat mild cognitive impairment after cerebral infarction: a randomized controlled trial. BMC Complement Altern Med. 2016;16:361.CrossRef Wang S, Yang H, Zhang J, Zhang B, Liu T, Gan L, et al. Efficacy and safety assessment of acupuncture and nimodipine to treat mild cognitive impairment after cerebral infarction: a randomized controlled trial. BMC Complement Altern Med. 2016;16:361.CrossRef
8.
go back to reference Farlow MR. Treatment of mild cognitive impairment (MCI). Curr Alzheimer Res. 2009;6(4):362–7.CrossRef Farlow MR. Treatment of mild cognitive impairment (MCI). Curr Alzheimer Res. 2009;6(4):362–7.CrossRef
9.
go back to reference Zhang X, Wu B, Nie K, Jia Y, Yu J. Effects of acupuncture on declined cerebral blood flow, impaired mitochondrial respiratory function and oxidative stress in multi-infarct dementia rats. Neurochem Int. 2014;65:23–9.CrossRef Zhang X, Wu B, Nie K, Jia Y, Yu J. Effects of acupuncture on declined cerebral blood flow, impaired mitochondrial respiratory function and oxidative stress in multi-infarct dementia rats. Neurochem Int. 2014;65:23–9.CrossRef
10.
go back to reference Lai X, Ren J, Lu Y, Cui S, Chen J, Huang Y, et al. Effects of acupuncture at HT7 on glucose metabolism in a rat model of Alzheimer’s disease: an 18F-FDG-PET study. Acupunct Med. 2016;34(3):215–22.CrossRef Lai X, Ren J, Lu Y, Cui S, Chen J, Huang Y, et al. Effects of acupuncture at HT7 on glucose metabolism in a rat model of Alzheimer’s disease: an 18F-FDG-PET study. Acupunct Med. 2016;34(3):215–22.CrossRef
11.
go back to reference Wang Z, Nie B, Li D, Zhao Z, Han Y, Song H, et al. Effect of acupuncture in mild cognitive impairment and Alzheimer disease: a functional MRI study. PLoS One. 2012;7(8):e42730-e.CrossRef Wang Z, Nie B, Li D, Zhao Z, Han Y, Song H, et al. Effect of acupuncture in mild cognitive impairment and Alzheimer disease: a functional MRI study. PLoS One. 2012;7(8):e42730-e.CrossRef
12.
go back to reference Jia B, Liu Z, Min B, Wang Z, Zhou A, Li Y, et al. The effects of acupuncture at real or sham acupoints on the intrinsic brain activity in mild cognitive impairment patients. Evid Based Complement Alternat Med. 2015;2015:529675.PubMedPubMedCentral Jia B, Liu Z, Min B, Wang Z, Zhou A, Li Y, et al. The effects of acupuncture at real or sham acupoints on the intrinsic brain activity in mild cognitive impairment patients. Evid Based Complement Alternat Med. 2015;2015:529675.PubMedPubMedCentral
13.
go back to reference Feng Y, Bai L, Ren Y, Chen S, Wang H, Zhang W, et al. FMRI connectivity analysis of acupuncture effects on the whole brain network in mild cognitive impairment patients. Magn Reson Imaging. 2012;30(5):672–82.CrossRef Feng Y, Bai L, Ren Y, Chen S, Wang H, Zhang W, et al. FMRI connectivity analysis of acupuncture effects on the whole brain network in mild cognitive impairment patients. Magn Reson Imaging. 2012;30(5):672–82.CrossRef
14.
go back to reference Zhong C, Bai L, Dai R, Xue T, Wang H, Feng Y, et al. Modulatory effects of acupuncture on resting-state networks: a functional MRI study combining independent component analysis and multivariate Granger causality analysis. J Magn Reson Imaging. 2012;35(3):572–81.CrossRef Zhong C, Bai L, Dai R, Xue T, Wang H, Feng Y, et al. Modulatory effects of acupuncture on resting-state networks: a functional MRI study combining independent component analysis and multivariate Granger causality analysis. J Magn Reson Imaging. 2012;35(3):572–81.CrossRef
15.
go back to reference Deng M, Wang X-F. Acupuncture for amnestic mild cognitive impairment: a meta-analysis of randomised controlled trials. Acupunct Med. 2016;34(5):342–8.CrossRef Deng M, Wang X-F. Acupuncture for amnestic mild cognitive impairment: a meta-analysis of randomised controlled trials. Acupunct Med. 2016;34(5):342–8.CrossRef
16.
go back to reference Choi JG, Moon M, Jeong HU, Kim MC, Kim SY, Oh MS. Cistanches Herba enhances learning and memory by inducing nerve growth factor. Behav Brain Res. 2011;216(2):652–8.CrossRef Choi JG, Moon M, Jeong HU, Kim MC, Kim SY, Oh MS. Cistanches Herba enhances learning and memory by inducing nerve growth factor. Behav Brain Res. 2011;216(2):652–8.CrossRef
17.
go back to reference Ahn SM, Kim YR, Kim HN, Shin HK, Choi BT. Beneficial effects of Polygonum multiflorum on hippocampal neuronal cells and mouse focal cerebral ischemia. Am J Chin Med. 2015;43(4):637–51.CrossRef Ahn SM, Kim YR, Kim HN, Shin HK, Choi BT. Beneficial effects of Polygonum multiflorum on hippocampal neuronal cells and mouse focal cerebral ischemia. Am J Chin Med. 2015;43(4):637–51.CrossRef
18.
go back to reference Zhang J, Liu Z, Zhang H, Yang C, Li H, Li X, et al. A two-year treatment of amnestic mild cognitive impairment using a compound Chinese medicine: a placebo controlled randomized trial. Sci Rep. 2016;6:28982.CrossRef Zhang J, Liu Z, Zhang H, Yang C, Li H, Li X, et al. A two-year treatment of amnestic mild cognitive impairment using a compound Chinese medicine: a placebo controlled randomized trial. Sci Rep. 2016;6:28982.CrossRef
19.
go back to reference Streitberger K, Kleinhenz J. Introducing a placebo needle into acupuncture research. Lancet (London, England). 1998;352(9125):364–5.CrossRef Streitberger K, Kleinhenz J. Introducing a placebo needle into acupuncture research. Lancet (London, England). 1998;352(9125):364–5.CrossRef
20.
go back to reference Yeung W-F, Chung K-F, Zhang S-P, Yap T-G, Law ACK. Electroacupuncture for primary insomnia: a randomized controlled trial. Sleep. 2009;32(8):1039–47.CrossRef Yeung W-F, Chung K-F, Zhang S-P, Yap T-G, Law ACK. Electroacupuncture for primary insomnia: a randomized controlled trial. Sleep. 2009;32(8):1039–47.CrossRef
21.
go back to reference Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9.CrossRef Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9.CrossRef
22.
go back to reference Tsai J-C, Chen C-W, Chu H, Yang H-L, Chung M-H, Liao Y-M, et al. Comparing the sensitivity, specificity, and predictive values of the Montreal Cognitive Assessment and Mini-Mental State Examination when screening people for mild cognitive impairment and dementia in Chinese population. Arch Psychiatr Nurs. 2016;30(4):486–91.CrossRef Tsai J-C, Chen C-W, Chu H, Yang H-L, Chung M-H, Liao Y-M, et al. Comparing the sensitivity, specificity, and predictive values of the Montreal Cognitive Assessment and Mini-Mental State Examination when screening people for mild cognitive impairment and dementia in Chinese population. Arch Psychiatr Nurs. 2016;30(4):486–91.CrossRef
23.
go back to reference Peng W, Zhou J, Xu M, Feng Q, Bin L, Liu Z. The effect of electroacupuncture combined with donepezil on cognitive function in Alzheimer's disease patients: study protocol for a randomized controlled trial. Trials. 2017;18(1):301–06. Peng W, Zhou J, Xu M, Feng Q, Bin L, Liu Z. The effect of electroacupuncture combined with donepezil on cognitive function in Alzheimer's disease patients: study protocol for a randomized controlled trial. Trials. 2017;18(1):301–06.
24.
go back to reference Leung AWN, Lam LCW, Kwan AKL, Tsang CLL, Zhang HW, Guo YQ, et al. Electroacupuncture for older adults with mild cognitive impairment: study protocol for a randomized controlled trial. Trials. 2015;16:232–36. Leung AWN, Lam LCW, Kwan AKL, Tsang CLL, Zhang HW, Guo YQ, et al. Electroacupuncture for older adults with mild cognitive impairment: study protocol for a randomized controlled trial. Trials. 2015;16:232–36.
25.
go back to reference Vidovich MR, Lautenschlager NT, Flicker L, Clare L, Almeida OP. The PACE study: a randomised clinical trial of cognitive activity (CA) for older adults with mild cognitive impairment (MCI). Trials. 2009;10:114–21. Vidovich MR, Lautenschlager NT, Flicker L, Clare L, Almeida OP. The PACE study: a randomised clinical trial of cognitive activity (CA) for older adults with mild cognitive impairment (MCI). Trials. 2009;10:114–21.
26.
go back to reference Liu T, Liu X, Xiao T, Shi J. Human recognition memory and conflict control: An event-related potential study. Neuroscience. 2016;313:83–91.CrossRef Liu T, Liu X, Xiao T, Shi J. Human recognition memory and conflict control: An event-related potential study. Neuroscience. 2016;313:83–91.CrossRef
27.
go back to reference Sculthorpe-Petley L, Liu C, Hajra SG, Parvar H, Satel J, Trappenberg TP, et al. A rapid event-related potential (ERP) method for point-of-care evaluation of brain function: development of the Halifax Consciousness Scanner. J Neurosci Methods. 2015;245:64–72.CrossRef Sculthorpe-Petley L, Liu C, Hajra SG, Parvar H, Satel J, Trappenberg TP, et al. A rapid event-related potential (ERP) method for point-of-care evaluation of brain function: development of the Halifax Consciousness Scanner. J Neurosci Methods. 2015;245:64–72.CrossRef
28.
go back to reference Richter FR, Yeung N. ERP correlates of encoding success and encoding selectivity in attention switching. PLoS One. 2016;11(12):e0167396-e.CrossRef Richter FR, Yeung N. ERP correlates of encoding success and encoding selectivity in attention switching. PLoS One. 2016;11(12):e0167396-e.CrossRef
29.
go back to reference Koepsell TD, Monsell SE. Reversion from mild cognitive impairment to normal or near-normal cognition: risk factors and prognosis. Neurology. 2012;79(15):1591–8.CrossRef Koepsell TD, Monsell SE. Reversion from mild cognitive impairment to normal or near-normal cognition: risk factors and prognosis. Neurology. 2012;79(15):1591–8.CrossRef
30.
go back to reference Roberts R, Knopman DS. Classification and epidemiology of MCI. Clin Geriatr Med. 2013;29(4):753–72.CrossRef Roberts R, Knopman DS. Classification and epidemiology of MCI. Clin Geriatr Med. 2013;29(4):753–72.CrossRef
31.
go back to reference Lin R, Chen J, Li X, Mao J, Wu Y, Zhuo P, et al. Electroacupuncture at the Baihui acupoint alleviates cognitive impairment and exerts neuroprotective effects by modulating the expression and processing of brain-derived neurotrophic factor in APP/PS1 transgenic mice. Mol Med Rep. 2016;13(2):1611–7.CrossRef Lin R, Chen J, Li X, Mao J, Wu Y, Zhuo P, et al. Electroacupuncture at the Baihui acupoint alleviates cognitive impairment and exerts neuroprotective effects by modulating the expression and processing of brain-derived neurotrophic factor in APP/PS1 transgenic mice. Mol Med Rep. 2016;13(2):1611–7.CrossRef
32.
go back to reference May BH, Lu C, Bennett L, Hügel HM, Xue CCL. Evaluating the traditional Chinese literature for herbal formulae and individual herbs used for age-related dementia and memory impairment. Biogerontology. 2012;13(3):299–312.CrossRef May BH, Lu C, Bennett L, Hügel HM, Xue CCL. Evaluating the traditional Chinese literature for herbal formulae and individual herbs used for age-related dementia and memory impairment. Biogerontology. 2012;13(3):299–312.CrossRef
33.
go back to reference Mao J, Huang S, Liu S, Feng X-L, Yu M, Liu J, et al. A herbal medicine for Alzheimer's disease and its active constituents promote neural progenitor proliferation. Aging Cell. 2015;14(5):784–96.CrossRef Mao J, Huang S, Liu S, Feng X-L, Yu M, Liu J, et al. A herbal medicine for Alzheimer's disease and its active constituents promote neural progenitor proliferation. Aging Cell. 2015;14(5):784–96.CrossRef
34.
go back to reference Geng Y, Li C, Liu J, Xing G, Zhou L, Dong M, et al. Beta-asarone improves cognitive function by suppressing neuronal apoptosis in the beta-amyloid hippocampus injection rats. Biol Pharm Bull. 2010;33(5):836–43.CrossRef Geng Y, Li C, Liu J, Xing G, Zhou L, Dong M, et al. Beta-asarone improves cognitive function by suppressing neuronal apoptosis in the beta-amyloid hippocampus injection rats. Biol Pharm Bull. 2010;33(5):836–43.CrossRef
35.
go back to reference Lee J-Y, Kim KY, Shin KY, Won BY, Jung HY, Suh Y-H. Effects of BT-11 on memory in healthy humans. Neurosci Lett. 2009;454(2):111–4.CrossRef Lee J-Y, Kim KY, Shin KY, Won BY, Jung HY, Suh Y-H. Effects of BT-11 on memory in healthy humans. Neurosci Lett. 2009;454(2):111–4.CrossRef
36.
go back to reference Shin KY, Lee J-Y, Won BY, Jung HY, Chang K-A, Koppula S, et al. BT-11 is effective for enhancing cognitive functions in the elderly humans. Neurosci Lett. 2009;465(2):157–9.CrossRef Shin KY, Lee J-Y, Won BY, Jung HY, Chang K-A, Koppula S, et al. BT-11 is effective for enhancing cognitive functions in the elderly humans. Neurosci Lett. 2009;465(2):157–9.CrossRef
37.
go back to reference Zhou H, Xue W, Chu S-F, Wang Z-Z, Li C-J, Jiang Y-N, et al. Polygalasaponin XXXII, a triterpenoid saponin from Polygalae radix, attenuates scopolamine-induced cognitive impairments in mice. Acta Pharmacol Sin. 2016;37(8):1045–53.CrossRef Zhou H, Xue W, Chu S-F, Wang Z-Z, Li C-J, Jiang Y-N, et al. Polygalasaponin XXXII, a triterpenoid saponin from Polygalae radix, attenuates scopolamine-induced cognitive impairments in mice. Acta Pharmacol Sin. 2016;37(8):1045–53.CrossRef
38.
go back to reference Wu M, Cui J, Xu D, Zhang K, Jing X, Bai W. Neuroanatomical characteristics of deep and superficial needling using LI11 as an example. Acupunct Med. 2015;33(6):472–7.CrossRef Wu M, Cui J, Xu D, Zhang K, Jing X, Bai W. Neuroanatomical characteristics of deep and superficial needling using LI11 as an example. Acupunct Med. 2015;33(6):472–7.CrossRef
39.
go back to reference MacPherson H, Green G, Nevado A, Lythgoe MF, Lewith G, Devlin R, et al. Brain imaging of acupuncture: comparing superficial with deep needling. Neurosci Lett. 2008;434(1):144–9.CrossRef MacPherson H, Green G, Nevado A, Lythgoe MF, Lewith G, Devlin R, et al. Brain imaging of acupuncture: comparing superficial with deep needling. Neurosci Lett. 2008;434(1):144–9.CrossRef
40.
go back to reference MacPherson H, Altman DG, Hammerschlag R, Youping L, Taixiang W, White A, et al. Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement. J Evid Based Med. 2010;3(3):140–55.CrossRef MacPherson H, Altman DG, Hammerschlag R, Youping L, Taixiang W, White A, et al. Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement. J Evid Based Med. 2010;3(3):140–55.CrossRef
Metadata
Title
Combination of acupuncture and Chinese herbal formula for elderly adults with mild cognitive impairment: protocol for a randomized controlled trial
Authors
Yueqi Chen
Wenjing Zhang
Huangan Wu
Lixing Lao
Jian Xu
Shifen Xu
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Trials / Issue 1/2019
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-019-3212-z

Other articles of this Issue 1/2019

Trials 1/2019 Go to the issue