Effectiveness of acupuncture combined with medication for mild cognitive impairment: a systematic review and meta-analysis protocol

Abstract

Abstract Introduction Cognitive impairment is a global health crisis, which reduces quality of life and adds to the socio-economic burden. Previous meta-analyses have shown that the combination of acupuncture and conventional Western medicine may offer advantages over drug therapy alone. However, uncertainties remain regarding the scope and timeliness of the evidence search, the use of outdated risk-of-bias assessment tools, safety and long-term outcomes, and specific clinical value. Therefore, this study will conduct an updated systematic review and meta-analysis aimed at evaluating the clinical efficacy of acupuncture combined with medication for patients with mild cognitive impairment (MCI), with the hope of providing guidance for optimizing clinical decision-making. Methods and analysis Search 9 databases (PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Data, VIP, China Biology Medicine disc, Scopus) from the start date to July 2026. We will also search trial registries and gray literature sources. Include randomized controlled trials comparing acupuncture combined with medication versus medication alone in patients with MCI. The primary outcomes will be the Montreal Cognitive Assessment Scale (MoCA) and the Mini-Mental State Examination (MMSE). Secondary outcomes included the Modified Barthel Index (MBI), Rey Auditory Verbal Learning Test (RAVLT), Digit Span Test, and Adverse Events (AE). Two researchers will independently conduct selection, extraction, and RoB 2 bias risk assessment. The GRADE framework will be used to assess the quality of evidence. Weighted mean differences (MD) and standardized mean differences (SMD) will be used for continuous outcomes. Relative risks (RRs)/odds ratios (ORs) with 95% confidence intervals (CIs) are going to be used for categorical data. Heterogeneity sources will be explored through sensitivity analysis and subgroup analysis. The publication bias will be assessed through funnel plots and Egger’s test. Discussion Comprehensive evidence to optimize clinical decision-making and treatment regarding the efficacy of acupuncture and pharmacotherapy in cognitive impairment. Systematic review registration PROSPERO CRD420261367845