Modulation of Brain Activity and Functional Connectivity by Acupuncture Combined With Donepezil on Mild-to-Moderate Alzheimer's Disease: A Neuroimaging Pilot Study

Abstract

BackgroundFunctional brain imaging changes have been proven as potential pathophysiological targets in early-stage AD. Current longitudinal neuroimaging studies of AD treated by acupuncture, which is one of the growingly acknowledged non-pharmacological interventions, have neither adopted comprehensive acupuncture protocols, nor explored the changes after a complete treatment duration. Thus, the mechanisms of acupuncture effects remain not fully investigated.ObjectiveThis study aimed to investigate the changes in spontaneous brain activity and functional connectivity and provide evidence for central mechanism of a 12-week acupuncture program on mild-to-moderate AD.MethodsA total of forty-four patients with mild-to-moderate AD and twenty-two age- and education-level-matched healthy subjects were enrolled in this study. The forty-four patients with AD received a 12-week intervention of either acupuncture combined with Donepezil (the treatment group) or Donepezil alone (the control group). The two groups received two functional magnetic resonance imaging (fMRI) scans before and after treatment. The healthy subject group underwent no intervention, and only one fMRI scan was performed after enrollment. The fractional amplitude of low-frequency fluctuation (fALFF) and functional connectivity (FC) were applied to analyze the imaging data. The correlations between the imaging indicators and the changed score of Alzheimer's Disease Assessment Scale-Cognitive Section (ADAS-cog) were also explored.ResultsAfter the 12-week intervention, compared to those in the control group, patients with AD in the treatment group scored significantly lower on ADAS-cog value. Moreover, compared to healthy subjects, the areas where the fALFF value decreased in patients with AD were mainly located in the right inferior temporal gyrus, middle/inferior frontal gyrus, middle occipital gyrus, left precuneus, and bilateral superior temporal gyrus. Compared with the control group, the right precuneus demonstrated the greatest changed value of fALFF after the intervention in the treatment group. The difference in ADAS-cog after interventions was positively correlated with the difference in fALFF value in the left temporal lobe. Right precuneus-based FC analysis showed that the altered FC by the treatment group compared to the control group was mainly located in the bilateral middle temporal gyrus.ConclusionThe study revealed the key role of precuneus in the effect of the combination of acupuncture and Donepezil on mild-to-moderate AD for cognitive function, as well as its connection with middle temporal gyrus, which provided a potential treating target for AD.Trial Registration Number:NCT03810794 (http://www.clinicaltrials.gov).

A Review of Acupuncture Combined with Pharmacology in the Treatment of Neurodegenerative Diseases: A Comprehensive Analysis

“…Yijun Zhan recruited a total of 44 patients diagnosed with mild to moderate AD and 22 healthy subjects as controls [1] . The AD patients were randomly assigned into either the treatment group or the control group.…”

Research status, hotspots and trends of acupuncture and moxibustion in the treatment of Alzheimer’s disease: A bibliometric analysis

“…The top 10 institutions with the most publications are listed in Table 2. The most productive institution was Beijing University of Chinese Medicine (36 publications), followed by Capital Medicine University (23) and Guangzhou University of Chinese Medicine ( 16). The highest average citation was Capital Medicine University (25.3) and the highest centrality (0.16), which indicated that it had a high influence and intermediary role.…”

“…The top 5 keyword co-occurrences and centrality are summarized in Table 5. The top frequency of keywords was AD (61), followed by acupuncture (39), dementia (36), memory (23), and the hippocampus (23). The keyword of high centrality indicates the hotspots and turning point of this field, and its value ranges from 0 to 1.…”

“…[13][14][15][16][17][18][19][20] Acupuncture and moxibustion (AM) have been widely used to ameliorate symptoms and improve the overall quality of life of patients with AD. [21][22][23][24][25][26][27][28][29] However, no study has explored the status, hotspots, and trends of AM in the treatment of AD. Therefore, this bibliometric analysis investigated the research status, hotspots, and trends of AM in the management of AD using VOSviewer and CiteSpace.…”

Neuroimaging studies of acupuncture on Alzheimer’s disease: a systematic review

“…Numerous studies have demonstrated that AD is one of the most prevalent central neurodegenerative diseases [ 29 – 31 ]. Brain imaging alterations have been considered the underlying pathological targets in AD [ 32 ]. Accordingly, it would be valuable to explore the central mechanisms of acupuncture in AD.…”