Neural mechanisms of acupuncture in amnestic mild cognitive impairment: a protocol for an fMRI-based systematic review and meta-analysis

Background: Amnestic mild cognitive impairment (aMCI), characterized by progressive memory decline, represents a prevalent transitional state in global aging populations and exhibits high conversion rates to Alzheimer's disease (AD), constituting a critical window for preventive interventions. While accumulating evidence supports acupuncture's efficacy in enhancing cognitive performance, the precise neural mechanisms underlying its therapeutic effects remain poorly characterized. This neuroimaging investigation aims to elucidate the cerebral reorganization patterns mediating acupuncture-induced cognitive improvement in aMCI pathophysiology. Methods and analysis: A systematic search strategy was implemented across eight electronic databases supplemented by manual searches, covering publications from each database's inception to May 1, 2025. Eligible study designs included randomized controlled trials (RCTs), prospective case-control studies, and observational investigations. Two independent investigators performed literature screening and data extraction, with discrepancies resolved through consensus or third-party adjudication. Methodological quality appraisal was conducted using the validated Agency for Healthcare Research and Quality (AHRQ) checklist. Primary outcomes focused on resting-state functional MRI (rs-fMRI) whole-brain functional imaging parameters. Meta-analytic synthesis of neuroimaging data will utilize seed-based d mapping with permutation of subject images (SDM-PSI, version 6.21), while clinical outcome analyses will be performed using RevMan 5.3 software (Cochrane Collaboration). Reporting will strictly adhere to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Conclusion: This study synthesizes findings from independent neuroimaging investigations to establish comprehensive evidence supporting the neurotherapeutic effects of acupuncture in aMCI. Systematic review registration: https://www.crd.york.ac.uk/prospero/, Identifier CRD420251033511.