{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T15:42:12Z","timestamp":1783525332051,"version":"3.55.0"},"reference-count":66,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Perioperative neurocognitive disorder (PND) is a common complication following major surgery under general anesthesia, particularly among elderly patients, and adversely impacts postoperative recovery and quality of life. Although electroacupuncture (EA) has shown potential in preventing PND, conclusive evidence remains lacking. This study aimed to evaluate the effectiveness and safety of perioperative EA intervention for preventing PND in elderly patients undergoing general anesthesia surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We systematically searched eight electronic databases [PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chongqing VIP Chinese Science and Technology Periodical Database (CQVIP), Wan Fang Database, and China Biology Medicine disc (CBM)] and three clinical trial registries from inception to March 16, 2025. Eligible studies were randomized controlled trials (RCTs) investigating perioperative EA for PND prevention in patients aged \u2265 60\u202fyears receiving general anesthesia. Control interventions included sham EA, standard care, or no intervention. Primary outcome was PND incidence. Secondary outcomes included neuropsychological assessment scores [Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA)], inflammatory biomarkers [serum interleukin-1\u03b2 (IL-1\u03b2), interleukin-6 (IL-6), and tumor necrosis factor-\u03b1 (TNF-\u03b1) levels], neurological damage markers [serum neuron-specific enolase (NSE), S100 calcium-binding protein \u03b2 (S100\u03b2) levels], and safety outcomes (incidence of adverse events). Two reviewers independently performed blind screening, data extraction, and risk-of-bias assessment using the Cochrane RoB 2 tool. Meta-analyses were conducted using RevMan 5.4, with random-effects or fixed-effect models applied based on heterogeneity (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      statistics). The certainty of evidence was evaluated with the GRADE.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-six RCTs (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f2,309) were included. Compared to the control groups, perioperative EA significantly reduced the incidence of PND (RR\u202f=\u202f0.47, 95% CI: 0.42 to 0.54,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.00001;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f0%; moderate to low certainty), improved MMSE scores (MD\u202f=\u202f1.92, 95% CI: 1.59 to 2.26,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.00001;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f96%; low to very low certainty), lowered serum IL-6 (SMD\u202f=\u202f\u22121.09, 95% CI: \u22121.73 to \u22120.44,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.0010;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f88%; very low certainty), IL-1\u03b2 (SMD\u202f=\u202f\u22122.85, 95% CI: \u22125.32 to \u22120.39,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.02;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f99%; very low certainty), TNF-\u03b1 (SMD\u202f=\u202f\u22122.64, 95% CI: \u22124.16 to \u22121.12,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.0007;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f98%; low certainty), and S100\u03b2 (SMD\u202f=\u202f\u22121.56, 95% CI: \u22122.77 to \u22120.35,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.01;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f97%; low certainty) levels, and reduced adverse events (RR\u202f=\u202f0.52, 95% CI: 0.37 to 0.72,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.0001;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f0%; moderate certainty). MoCA scores and serum NSE levels could not be meta-analyzed due to insufficient data.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Perioperative EA intervention demonstrates significant clinical benefits in elderly patients undergoing general anesthesia surgery, effectively reducing PND incidence, improving cognitive function, attenuating neuroinflammation, and reducing neurological injury with a favorable safety profile. However, current evidence is constrained by methodological limitations, including potential selection bias and insufficient blinding in the included studies. Future rigorously designed multicenter RCTs with standardized EA featuring standardized EA protocols and long-term cognitive monitoring are needed to confirm its neuroprotective effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/<\/jats:ext-link>\n                      , identifier CRD420251035172.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1729153","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T06:45:29Z","timestamp":1769150729000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Electroacupuncture for the prevention of perioperative neurocognitive disorder in elderly patients undergoing general anesthesia: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Changle","family":"Wu","sequence":"first","affiliation":[{"name":"Acupuncture Anesthesia Clinical Research Institute, Shanghai Acupuncture Clinical Research Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuqiang","family":"Wei","sequence":"additional","affiliation":[{"name":"Acupuncture Anesthesia Clinical Research Institute, Shanghai Acupuncture Clinical Research Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Renmin Hospital, Hubei University of Medicine","place":["Shiyan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinyun","family":"Li","sequence":"additional","affiliation":[{"name":"School of Foreign Studies, Fuzhou University","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan Yin Joseph","family":"Kwan","sequence":"additional","affiliation":[{"name":"Faculty of Health and Life Sciences, University of Bristol","place":["Bristol, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Wang","sequence":"additional","affiliation":[{"name":"Acupuncture Anesthesia Clinical Research Institute, Shanghai Acupuncture Clinical Research Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Zhou","sequence":"additional","affiliation":[{"name":"Acupuncture Anesthesia Clinical Research Institute, Shanghai Acupuncture Clinical Research Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1111\/cns.13873","article-title":"Perioperative neurocognitive disorders: a narrative review focusing on diagnosis, prevention, and treatment","volume":"28","author":"Kong","year":"2022","journal-title":"CNS Neurosci Ther"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1016\/j.bja.2017.11.087","article-title":"Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery","volume":"121","author":"Evered","year":"2018","journal-title":"Br J Anaesth"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1016\/S0140-6736(13)60688-1","article-title":"Delirium in elderly people","volume":"383","author":"Inouye","year":"2014","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"885","DOI":"10.4065\/mcp.2011.0332","article-title":"Perioperative cognitive decline in the aging population","volume":"86","author":"Terrando","year":"2011","journal-title":"Mayo Clin Proc"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1007\/s41999-019-00257-2","article-title":"The financial and social costs of delirium","volume":"11","author":"Caplan","year":"2020","journal-title":"Eur Geriatr Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1038\/s41582-022-00698-7","article-title":"The inter-relationship between delirium and dementia: the importance of delirium prevention","volume":"18","author":"Fong","year":"2022","journal-title":"Nat Rev Neurol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1001\/jamasurg.2015.2606","article-title":"Effect of delirium and other major complications on outcomes after elective surgery in older adults","volume":"150","author":"Gleason","year":"2015","journal-title":"JAMA Surg"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1001\/jama.2010.1013","article-title":"Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis","volume":"304","author":"Witlox","year":"2010","journal-title":"JAMA"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1016\/j.bja.2020.10.037","article-title":"Improving perioperative brain health: an expert consensus review of key actions for the perioperative care team","volume":"126","author":"Peden","year":"2021","journal-title":"Br J Anaesth"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1186\/s12974-019-1665-3","article-title":"Electroacupuncture attenuates cognition impairment via anti-neuroinflammation in an Alzheimer\u2019s disease animal model","volume":"16","author":"Cai","year":"2019","journal-title":"J Neuroinflammation"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.neulet.2005.09.049","article-title":"Acupuncture prevents cognitive deficits and oxidative stress in cerebral multi-infarction rats","volume":"393","author":"Liu","year":"2006","journal-title":"Neurosci Lett"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"582904","DOI":"10.3389\/fnagi.2020.582904","article-title":"Acupuncture improves White matter perfusion and integrity in rat model of vascular dementia: an MRI-based imaging study","volume":"12","author":"Ma","year":"2020","journal-title":"Front Aging Neurosci"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"955581","DOI":"10.3389\/fimmu.2022.955581","article-title":"Electroacupuncture attenuates surgical pain-induced delirium-like behavior in mice via remodeling gut microbiota and dendritic spine","volume":"13","author":"Yang","year":"2022","journal-title":"Front Immunol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.brainres.2014.10.005","article-title":"The effects of electroacupuncture treatment on the postoperative cognitive function in aged rats with acute myocardial ischemia-reperfusion","volume":"1593","author":"Yuan","year":"2014","journal-title":"Brain Res"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"778474","DOI":"10.3389\/fmed.2021.778474","article-title":"Electroacupuncture for the prevention of postoperative cognitive dysfunction among older adults undergoing hip and knee arthroplasty: a systematic review and Meta-analysis of randomized controlled trials","volume":"8","author":"Ou","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"189","DOI":"10.3892\/ol.2017.7262","article-title":"Combined acupuncture and general anesthesia on immune and cognitive function in elderly patients following subtotal gastrectomy for gastric cancer","volume":"15","author":"Wang","year":"2018","journal-title":"Oncol Lett"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e7375","DOI":"10.1097\/MD.0000000000007375","article-title":"Effects of preconditioning of electro-acupuncture on postoperative cognitive dysfunction in elderly: a prospective, randomized, controlled trial","volume":"96","author":"Zhang","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"ref18","first-page":"7","article-title":"Evaluation of efficacy and safety of electro-acupuncture precondition on postoperative cognitive dysfunction (POCD) following knee replacement in elderly: a randomized controlled trial","volume":"5","author":"Zhao","year":"2019","journal-title":"World J Integr Tradit West Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1016\/j.wjam.2018.11.003","article-title":"The effect of electroacupuncture preconditioning on cognitive impairments following knee replacement among elderly: a randomized controlled trial","volume":"28","author":"Zhao","year":"2018","journal-title":"World J Acupunct Moxibustion"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.gerinurse.2022.05.010","article-title":"Transcutaneous electrical acupoint stimulation affects older adults\u2019 cognition after general anesthesia: a meta-analysis","volume":"46","author":"Chen","year":"2022","journal-title":"Geriatr Nurs"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e0313622","DOI":"10.1371\/journal.pone.0313622","article-title":"Intraoperative transcutaneous electrical acupoint stimulation combined with anesthesia to prevent postoperative cognitive dysfunction: a systematic review and meta-analysis","volume":"20","author":"Gan","year":"2025","journal-title":"PLoS One"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"907","DOI":"10.2147\/NDT.S404805","article-title":"Transcutaneous electrical acupoint stimulation for preventing postoperative delirium: a meta-analysis","volume":"19","author":"Guo","year":"2023","journal-title":"Neuropsychiatr Dis Treat"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1046754","DOI":"10.3389\/fnagi.2023.1046754","article-title":"Transcutaneous electrical acupoint stimulation for the prevention of postoperative delirium in elderly surgical patients: a systematic review and meta-analysis","volume":"15","author":"Huang","year":"2023","journal-title":"Front Aging Neurosci"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e0309673","DOI":"10.1371\/journal.pone.0309673","article-title":"Evaluation of transcutaneous electrical acupoint stimulation for improving pain and cognitive function in elderly patients around the perioperative period of hip replacement surgery: a meta-analysis","volume":"19","author":"Xu","year":"2024","journal-title":"PLoS One"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"756366","DOI":"10.3389\/fmed.2021.756366","article-title":"Transcutaneous electrical Acupoint stimulation for the prevention of postoperative cognitive dysfunction: a systematic review and Meta-analysis","volume":"8","author":"Zhang","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"ED000142","DOI":"10.1002\/14651858.ED000142","article-title":"Updated guidance for trusted systematic reviews: a new edition of the Cochrane handbook for systematic reviews of interventions","volume":"10","author":"Cumpston","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref28","volume-title":"Cochrane handbook for systematic reviews of interventions. Cochrane book series","author":"Green","year":"2008"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: an emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1002\/jrsm.12","article-title":"A basic introduction to fixed-effect and random-effects models for meta-analysis","volume":"1","author":"Borenstein","year":"2010","journal-title":"Res Synth Methods"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"d4002","DOI":"10.1136\/bmj.d4002","article-title":"Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials","volume":"343","author":"Sterne","year":"2011","journal-title":"BMJ"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"82","DOI":"10.12037\/YXQY.2016.09-10","article-title":"Prevention and cure effect of electroacupuncture before anesthesia on postoperative cognitive dysfunction in elderly patients","volume":"8","author":"Dong","year":"2016","journal-title":"Chin J Front Med Sci"},{"key":"ref34","first-page":"591","article-title":"Effects of electroacupuncture assistant general anesthesia on postoperative cognitive dysfunction of aged patients","volume":"32","author":"Gao","year":"2012","journal-title":"Chin J Integr Med"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"210","DOI":"10.13457\/j.cnki.jncm.2022.11.046","article-title":"Effect of acupuncture-assisted anesthesia on analgesic effect and adverse reactions after lumbar fusion in the senile","volume":"54","author":"Gu","year":"2022","journal-title":"J New Chin Med"},{"key":"ref36","first-page":"68","article-title":"Effect of acupuncture-combined anesthesia on postoperative cognitive function in elderly patients undergoing colorectal cancer resection","volume":"47","author":"Han","year":"2018","journal-title":"Heilongjiang J Tradit Chin Med"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"95","DOI":"10.13862\/j.cnki.cn43-1446\/r.2018.08.030","article-title":"Effects of electroacupuncture on immune function, adrenal stress and cognitive function in elder1y patients undergoing hip replacement","volume":"24","author":"Liu","year":"2018","journal-title":"Guid J Tradit Chin Med Pharm"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"63","DOI":"10.13703\/j.0255-2930.2013.01.024","article-title":"Influences of acupuncture anesthesia on postoperative cognitive dysfunction and S-100\u03b2 protein level of the elderly patients of colorectal cancer resection","volume":"33","author":"Lin","year":"2013","journal-title":"Chin Acupunct Moxibust"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"795","DOI":"10.7661\/CJIM.2014.07.0795","article-title":"Effect of acupuncture-anesthetic composite anesthesia on the incidence of POCD and TNF-a, IL1\u03b2, IL-6 in elderly patients","volume":"34","author":"Lin","year":"2014","journal-title":"Chin J Integr Med"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.3969\/j.issn.1002-1256.2023.12.004","article-title":"Effects of combined acupuncture and drug anesthesia on cognitive function and heart rate variability in elderly patients undergoing hip replacement","volume":"44","author":"Liu","year":"2023","journal-title":"J Qiqihar Med Univ"},{"key":"ref41","first-page":"76","article-title":"Effect of acupuncture combined with general anesthesia on cognitive function and related inflammatory factors in elderly patients with tumor resection","volume":"14","author":"Liu","year":"2017","journal-title":"Chin Med Herald"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"2858","DOI":"10.3969\/j.issn.1673-7202.2018.11.048","article-title":"Effects of acupuncture anesthesia and gas anesthesia on elderly patients with postoperative cognitive dysfunction and NSE, S-100\u03b2 protein levels change","volume":"13","author":"Liu","year":"2018","journal-title":"World J Tradit Chin Med"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"94","DOI":"10.3969\/j.issn.1009-3257.2022.09.043","article-title":"Effects of electroacupuncture at Yongquan (KI1), Shenmen (HT7) and Baihui (GV20) on postoperative cognitive dysfunction in elderly patients","volume":"29","author":"Tang","year":"2022","journal-title":"J Rare Uncommon Dis"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"12","DOI":"10.13460\/j.issn.1005-0957.2023.01.0012","article-title":"Impact of electroacupuncture pretreatment on the cognitive function in older patients after holmium laser lithotripsy under flexible ureteroscope","volume":"42","author":"Wan","year":"2023","journal-title":"Shanghai J Acu-mox"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"123","DOI":"10.3969\/j.issn.1672-2779.2019.13.051","article-title":"Effects of acupuncture anesthesia induction on postoperative cognitive function and inflammatory factors in elderly patients","volume":"17","author":"Wang","year":"2019","journal-title":"Chin Med Mod Distance Educ China"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"466","DOI":"10.20135\/j.issn.1006-8147.2020.05.018","article-title":"Effect of intraoperative electro-acupuncture on the incidence of postoperative delirium in elderly patients","volume":"26","author":"Wu","year":"2020","journal-title":"J Tianjin Med Univ"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"300","DOI":"10.13460\/j.issn.1005-0957.2017.03.0300","article-title":"Clinical study of perioperative electroacupuncture intervention in postoperative delirium in hip replacement surgery patients","volume":"36","author":"Yang","year":"2017","journal-title":"Shanghai J Acu-mox"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"192","DOI":"10.13457\/j.cnki.jncm.2018.09.055","article-title":"Clinical study of acupuncture preconditioning for prostatic hypertrophy with postoperative cognitive dysfunction in early stage","volume":"50","author":"Yang","year":"2018","journal-title":"J New Chin Med"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"1070","DOI":"10.3969\/j.issn.1000-7369.2016.08.062","article-title":"Effects of acupuncture combined with general anesthesia on postoperative cognitive function in elderly patients undergoing colorectal cancer resection","volume":"37","author":"Yu","year":"2016","journal-title":"Shaanxi J Tradit Chin Med"},{"key":"ref50","first-page":"125","article-title":"Clinical study on electroacupuncture at Baihui (GV20) and Neiguan (PC6) for postoperative cognitive recovery in elderly patients under general anesthesia","volume":"29","author":"Yuan","year":"2019","journal-title":"Chin Health Care Nutr"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"132","DOI":"10.13460\/j.issn.1005-0957.2015.02.0132","article-title":"Effect of electroacupuncture on the recovery of cognitive function after operation under general anesthesia in the elderly","volume":"34","author":"Zhang","year":"2015","journal-title":"Shanghai J Acu-mox"},{"key":"ref52","volume-title":"Influence of electroacupuncture before operation on post-operative cognitive dysfunction in elderly patients undergoing total hip joint or total knee replacement","author":"Zhang","year":"2011"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"370","DOI":"10.13193\/j.issn.1673-7717.2014.02.052","article-title":"Clinical observation of electroacupuncture on postoperative cognitive dysfunction in elderly patients","volume":"32","author":"Zhang","year":"2014","journal-title":"Chin Arch Tradit Chin Med"},{"key":"ref54","first-page":"107","article-title":"Clinical effect of acupuncture at the Xingshen four points on promoting cognitive recovery of elderly patients after general anesthesia","volume":"59","author":"Zhao","year":"2021","journal-title":"Chin Mod Dr"},{"key":"ref55","first-page":"199","article-title":"Impact of electroacupuncture prevention on cognitive function and serum HIF-1\u03b1 in elderly patients after hip replacement","author":"Zheng","year":"2023","journal-title":"Health Guide"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1002\/alz.12075","article-title":"International drive to illuminate delirium: a developing public health blueprint for action","volume":"16","author":"Khachaturian","year":"2020","journal-title":"Alzheimers Dement"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1177\/0964528420961393","article-title":"Acupuncture for post-operative cognitive dysfunction: a systematic review and meta-analysis of randomized controlled trials","volume":"39","author":"Tang","year":"2021","journal-title":"Acupunct Med"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1016\/j.ebiom.2018.10.021","article-title":"Surgery, neuroinflammation and cognitive impairment","volume":"37","author":"Alam","year":"2018","journal-title":"EBioMedicine"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1038\/s41586-021-04001-4","article-title":"A neuroanatomical basis for electroacupuncture to drive the vagal-adrenal axis","volume":"598","author":"Liu","year":"2021","journal-title":"Nature"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"914049","DOI":"10.3389\/fnagi.2022.914049","article-title":"Effect of acupuncture on brain regions modulation of mild cognitive impairment: a meta-analysis of functional magnetic resonance imaging studies","volume":"14","author":"Ma","year":"2022","journal-title":"Front Aging Neurosci"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"250","DOI":"10.4103\/1673-5374.200808","article-title":"Modulatory effects of acupuncture on brain networks in mild cognitive impairment patients","volume":"12","author":"Tan","year":"2017","journal-title":"Neural Regen Res"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/s0166-2236(02)00006-1","article-title":"Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies","volume":"26","author":"Han","year":"2003","journal-title":"Trends Neurosci"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1097\/CM9.0000000000000123","article-title":"Perioperative acupuncture medicine: a novel concept instead of acupuncture anesthesia","volume":"132","author":"Yuan","year":"2019","journal-title":"Chin Med J"},{"key":"ref64","doi-asserted-by":"publisher","first-page":"c332","DOI":"10.1136\/bmj.c332","article-title":"CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials","volume":"340","author":"Schulz","year":"2010","journal-title":"BMJ"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"e1000261","DOI":"10.1371\/journal.pmed.1000261","article-title":"Revised STandards for reporting interventions in clinical trials of acupuncture (STRICTA): extending the CONSORT statement","volume":"7","author":"MacPherson","year":"2010","journal-title":"PLoS Med"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1111\/jebm.12560","article-title":"The SHARE: SHam acupuncture REporting guidelines and a checklist in clinical trials","volume":"16","author":"Ma","year":"2023","journal-title":"J Evid Based Med"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1729153\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T09:10:10Z","timestamp":1771924210000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1729153\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,23]]},"references-count":66,"alternative-id":["10.3389\/fmed.2026.1729153"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1729153","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,23]]},"article-number":"1729153"}}