{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T10:20:57Z","timestamp":1785320457688,"version":"3.55.0"},"reference-count":53,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2021,7,13]],"date-time":"2021-07-13T00:00:00Z","timestamp":1626134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"publisher","award":["HF20C0207"],"award-info":[{"award-number":["HF20C0207"]}],"id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Dementia is an important health issue worldwide, and non-pharmacological strategies for the management of behavioral and psychological symptoms of dementia (BPSD) are considered to be important. This review analyzes the effectiveness and safety of acupuncture for BPSD. Thirteen electronic databases were comprehensively searched to find clinical studies using acupuncture on BPSD, published up to December 2020. Five randomized controlled clinical trials and two before-after studies, mainly on Alzheimer\u2019s disease (AD), were included. Meta-analysis suggested that the total effective rate based on BPSD symptoms in the acupuncture combined with psychotropic drugs group was significantly higher than that in the psychotropic drugs group (risk ratio, 1.27; 95% confidence interval, 1.11 to 1.45; I2 = 51%). In terms of other outcomes related to BPSD, acupuncture as an adjunctive therapy, but not as monotherapy, was associated with significant benefits in most included studies. However, the included studies did not have optimal methodological quality. Our review highlights the limited evidence proving the effectiveness and safety of acupuncture for BPSD in patients with AD. Although some clinical studies have reported the potential benefits of adjuvant acupuncture in managing BPSD, the evidence is not robust and is based on small studies. Therefore, high-quality research in this field is needed.<\/jats:p>","DOI":"10.3390\/jcm10143087","type":"journal-article","created":{"date-parts":[[2021,7,13]],"date-time":"2021-07-13T22:25:31Z","timestamp":1626215131000},"page":"3087","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Acupuncture for Behavioral and Psychological Symptoms of Dementia: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0068-9904","authenticated-orcid":false,"given":"Chan-Young","family":"Kwon","sequence":"first","affiliation":[{"name":"Department of Oriental Neuropsychiatry, Dong-eui University College of Korean Medicine, 52-57 Yangjeong-ro, Busanjin-gu, Busan 47227, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1679-0644","authenticated-orcid":false,"given":"Boram","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul 02447, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/S0140-6736(20)30367-6","article-title":"Dementia prevention, intervention, and care: 2020 report of the Lancet Commission","volume":"396","author":"Livingston","year":"2020","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.1212\/WNL.0b013e31828726f5","article-title":"Alzheimer disease in the United States (2010\u20132050) estimated using the 2010 census","volume":"80","author":"Hebert","year":"2013","journal-title":"Neurology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.jalz.2012.11.007","article-title":"The global prevalence of dementia: A systematic review and metaanalysis","volume":"9","author":"Prince","year":"2013","journal-title":"Alzheimers Dement."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1017\/S104161021700237X","article-title":"Relationship between the number of behavioral symptoms in dementia and caregiver distress: What is the tipping point?","volume":"30","author":"Arthur","year":"2018","journal-title":"Int. Psychogeriatr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1002\/gps.490","article-title":"The cost of behavioral and psychological symptoms of dementia (BPSD) in community dwelling Alzheimer\u2019s disease patients","volume":"17","author":"Beeri","year":"2002","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1177\/1756285617712979","article-title":"Best practice in the management of behavioural and psychological symptoms of dementia","volume":"10","author":"Tible","year":"2017","journal-title":"Ther. Adv. Neurol. Disord."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1017\/S1041610218000534","article-title":"Management of behavioral and psychological symptoms in people with Alzheimer\u2019s disease: An international Delphi consensus","volume":"31","author":"Kales","year":"2019","journal-title":"Int. Psychogeriatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.2147\/NDT.S163842","article-title":"Treatment of behavioral and psychological symptoms of dementias with psychopharmaceuticals: A review","volume":"14","author":"Masopust","year":"2018","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1002\/gps.4463","article-title":"The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: A longitudinal cohort study","volume":"32","author":"White","year":"2016","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1007\/s40801-015-0047-0","article-title":"Behavioral and Psychological Symptoms of Dementia and Antipsychotic Drug Use in the Elderly with Dementia in Korean Long-Term Care Facilities","volume":"2","author":"Lee","year":"2015","journal-title":"Drugs-Real World Outcomes"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/j.jamda.2011.07.006","article-title":"What Are the Barriers to Performing Nonpharmacological Interventions for Behavioral Symptoms in the Nursing Home?","volume":"13","author":"Thein","year":"2012","journal-title":"J. Am. Med Dir. Assoc."},{"key":"ref_12","first-page":"716","article-title":"Medicare Proposes Coverage of Acupuncture for Lower Back Pain","volume":"322","author":"Rubin","year":"2019","journal-title":"JAMA"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1177\/0193945919890552","article-title":"Acupuncture and Acupressure for Dementia Behavioral and Psychological Symptoms: A Scoping Review","volume":"42","author":"Harris","year":"2019","journal-title":"West. J. Nurs. Res."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Ma, Y., Dong, M., Zhou, K., Mita, C., Liu, J., and Wayne, P.M. (2016). Publication Trends in Acupuncture Research: A 20-Year Bibliometric Analysis Based on PubMed. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0168123"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.imr.2018.07.005","article-title":"Treating the patient not the symptoms: Acupuncture to improve overall health\u2013Evidence, acceptance and strategies","volume":"8","author":"Birch","year":"2019","journal-title":"Integr. Med. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-017-03272-0","article-title":"Safety of Acupuncture: Overview of Systematic Reviews","volume":"7","author":"Chan","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/s00401-011-0821-3","article-title":"Clinicopathological correlates of behavioral and psychological symptoms of dementia","volume":"122","author":"Casanova","year":"2011","journal-title":"Acta Neuropathol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"47","DOI":"10.3389\/fnint.2019.00047","article-title":"Effects of Acupuncture on Neurological Disease in Clinical- and Animal-Based Research","volume":"13","author":"Guo","year":"2019","journal-title":"Front. Integr. Neurosci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"387","DOI":"10.3233\/JAD-150181","article-title":"Associations between Neuropsychiatric Symptoms and Cerebral Amyloid Deposition in Cognitively Impaired Elderly People","volume":"49","author":"Bensamoun","year":"2015","journal-title":"J. Alzheimers Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13024-021-00456-1","article-title":"Brain mechanisms underlying neuropsychiatric symptoms in Alzheimer\u2019s disease: A systematic review of symptom-general and \u2013specific lesion patterns","volume":"16","author":"Chen","year":"2021","journal-title":"Mol. Neurodegener."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e24341","DOI":"10.1097\/MD.0000000000024341","article-title":"Acupuncture for behavioral and psychological symptoms of dementia","volume":"100","author":"Kwon","year":"2021","journal-title":"Medicine"},{"key":"ref_22","doi-asserted-by":"crossref","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":"ref_23","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1002\/(SICI)1099-1166(199609)11:9<819::AID-GPS389>3.0.CO;2-S","article-title":"The behavior pathology in Alzheimer\u2019s disease rating scale (Behave-AD): Reliability and analysis of symptom category scores","volume":"11","author":"Sclan","year":"1996","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2308","DOI":"10.1212\/WNL.44.12.2308","article-title":"The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia","volume":"44","author":"Cummings","year":"1994","journal-title":"Neurology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"799","DOI":"10.2466\/pr0.1962.10.3.799","article-title":"The brief psychiatric rating scale","volume":"10","author":"Overall","year":"1962","journal-title":"Psychol. Rep."},{"key":"ref_26","first-page":"61","article-title":"Functional evaluation: The Barthel Index: A simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill","volume":"14","author":"Mahoney","year":"1965","journal-title":"Md. State Med. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S152","DOI":"10.1097\/01.wad.0000213873.25053.2b","article-title":"ADCS Prevention Instrument Project: Assessment of Instrumental Activities of Daily Living for Community-dwelling Elderly Individuals in Dementia Prevention Clinical Trials","volume":"20","author":"Galasko","year":"2006","journal-title":"Alzheimer Dis. Assoc. Disord."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1097\/WAD.0b013e31819b02bc","article-title":"Evaluation of the validity and reliability of the Alzheimer\u2019s Disease-Related Quality of Life (ADRQL) assessment instrument","volume":"23","author":"Kasper","year":"2009","journal-title":"Alzheimer Dis. Assoc. Disord."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1093\/geront\/29.6.798","article-title":"Application of a multidimensional caregiver burden inventory","volume":"29","author":"Novak","year":"1989","journal-title":"Gerontologist"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/00005650-199206000-00002","article-title":"The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection","volume":"30","author":"Ware","year":"1992","journal-title":"Med. Care"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Higgins, J., and Altman, D. (2008). Assessing Risk of Bias in Included Studies. Cochrane Handbook for Systematic Reviews of Interventions, John Wiley & Sons, Ltd.","DOI":"10.1002\/9780470712184.ch8"},{"key":"ref_32","unstructured":"National Heart, Lung, and Blood Institute (NHLBI) (2021, February 25). Study Quality Assessment Tools, Available online: https:\/\/www.nhlbi.nih.gov\/health-topics\/study-quality-assessment-tools."},{"key":"ref_33","unstructured":"Guyatt, G., Rennie, D., Meade, M., and Cook, D. (2002). Users\u2019 Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, AMA Press."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.jclinepi.2010.07.015","article-title":"GRADE guidelines: 3. Rating the quality of evidence","volume":"64","author":"Balshem","year":"2011","journal-title":"J. Clin. Epidemiol."},{"key":"ref_35","first-page":"16","article-title":"Clinical observation of electric acupuncture combined with fentazin in treating mental symptom of alzheimer\u2019s disease","volume":"19","author":"Ou","year":"2000","journal-title":"Shanghai J. Acupunct. Moxibustion"},{"key":"ref_36","first-page":"1279","article-title":"Study on the effect of scalp-point cluster needling method on depression caused by Alzheimer\u2019s disease and its rehabilitation","volume":"36","author":"Huang","year":"2014","journal-title":"Guangxi Med. J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12906-017-2064-x","article-title":"Acupuncture for patients with mild to moderate Alzheimer\u2019s disease: A randomized controlled trial","volume":"17","author":"Jia","year":"2017","journal-title":"BMC Complement. Altern. Med."},{"key":"ref_38","first-page":"1471","article-title":"Clinical Observation of Electroacupuncture Combined with Midazolam Maleate in Improving Alzheimer\u2019s Disease Sleep Disorder","volume":"38","author":"Zhang","year":"2017","journal-title":"Shaanxi J. Tradit. Chin. Med."},{"key":"ref_39","first-page":"1998","article-title":"Effects of Acusector Combined with Music Therapy on Cognitive Function and Activities of Daily Living in Patients with Mild and Moderate Alzheimer\u2019s Disease","volume":"15","author":"Zhao","year":"2020","journal-title":"World Chin. Med."},{"key":"ref_40","first-page":"28","article-title":"Acupuncture as treatment for anxiety and depression in persons with dementia: Results of a feasibility and effectiveness study","volume":"2","author":"Lombardo","year":"2001","journal-title":"Alzheimers Care Q."},{"key":"ref_41","unstructured":"Ying, J. (2006). Clinical Study on the Effect of Acupuncture on Mental and Behavioral Symptoms of Alzheimer\u2019s Disease. [Master\u2019s Thesis, Chengdu University of Traditional Chinese Medicine]."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1186\/1745-6215-15-264","article-title":"Sample size requirements to estimate key design parameters from external pilot randomised controlled trials: A simulation study","volume":"15","author":"Teare","year":"2014","journal-title":"Trials"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1089\/acm.2017.0239","article-title":"Long-Term Acupuncture Therapy for Low-Income Older Adults with Multimorbidity: A Qualitative Study of Patient Perceptions","volume":"24","author":"Pagones","year":"2018","journal-title":"J. Altern. Complement. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"517","DOI":"10.3233\/BMR-140550","article-title":"\u00d6zlem Effective chronic low back pain and knee pain treatment with acupuncture in geriatric patients","volume":"28","author":"Anil","year":"2015","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.4103\/1673-5374.211197","article-title":"Long-term acupuncture treatment has a multi-targeting regulation on multiple brain regions in rats with Alzheimer\u2019s disease: A positron emission tomography study","volume":"12","author":"Huang","year":"2017","journal-title":"Neural Regen. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2018\/7619197","article-title":"Neuronal Specificity of Acupuncture in Alzheimer\u2019s Disease and Mild Cognitive Impairment Patients: A Functional MRI Study","volume":"2018","author":"Shan","year":"2018","journal-title":"Evid. Based Complement. Altern. Med."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Huang, W., Pach, D., Napadow, V., Park, K., Long, X., Neumann, J., Maeda, Y., Nierhaus, T., Liang, F., and Witt, C.M. (2012). Characterizing Acupuncture Stimuli Using Brain Imaging with fMRI-A Systematic Review and Meta-Analysis of the Literature. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0032960"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"61","DOI":"10.2174\/1567205013666160603010203","article-title":"Neuroimaging Findings Related to Behavioral Disturbances in Alzheimer\u2019s Disease: A Systematic Review","volume":"14","author":"Alves","year":"2016","journal-title":"Curr. Alzheimer Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1159\/000194658","article-title":"Neuroanatomy of Apathy and Disinhibition in Frontotemporal Lobar Degeneration","volume":"27","author":"Massimo","year":"2009","journal-title":"Dement. Geriatr. Cogn. Disord."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.2174\/1567205013666160502123607","article-title":"Neuropsychiatric Disturbances in Alzheimer\u2019s Disease: What Have We Learned from Neuropathological Studies?","volume":"13","author":"Vermeiren","year":"2016","journal-title":"Curr. Alzheimer Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.pneurobio.2016.04.001","article-title":"Monoaminergic neuropathology in Alzheimer\u2019s disease","volume":"151","author":"Wray","year":"2017","journal-title":"Prog. Neurobiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1176\/jnp.2006.18.2.191","article-title":"White Matter Changes Associated With Psychotic Symptoms in Alzheimer\u2019s Disease Patients","volume":"18","author":"Lee","year":"2006","journal-title":"J. Neuropsychiatry Clin. Neurosci."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"14","DOI":"10.3389\/fpsyt.2019.00014","article-title":"The Effects of Acupuncture on Glutamatergic Neurotransmission in Depression, Anxiety, Schizophrenia, and Alzheimer\u2019s Disease: A Review of the Literature","volume":"10","author":"Tu","year":"2019","journal-title":"Front. Psychiatry"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/14\/3087\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:29:54Z","timestamp":1760164194000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/14\/3087"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,13]]},"references-count":53,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2021,7]]}},"alternative-id":["jcm10143087"],"URL":"https:\/\/doi.org\/10.3390\/jcm10143087","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,13]]}}}