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Background: Vascular dementia (VaD) is characterized by progressive cognitive impairment associated with chronic cerebral hypoperfusion. Monoaminergic neurotransmitter dysfunction has been implicated in its pathogenesis. Acupuncture has shown neuroprotective potential in experimental models; however, its regulatory effects on monoaminergic systems remain to be systematically clarified. This study aimed to evaluate the effects of acupuncture on monoaminergic neurotransmitters and cognitive function in animal models of VaD through a preclinical systematic review and meta-analysis. Methods: In accordance with the PRISMA 2020 guidelines, a comprehensive search across eight English and Chinese databases was conducted from inception to October 2025 to identify randomized controlled animal studies investigating acupuncture in VaD models. Primary outcomes focused on the levels of monoaminergic neurotransmitters, including serotonin (5-HT), norepinephrine (NE), and dopamine (DA). Secondary outcomes encompassed acetylcholine (ACh) levels, long-term potentiation (LTP), and behavioral performance. Risk of bias was systematically assessed using the SYRCLE tool, and statistical synthesis was performed using R software (version 4.3.1). Results: Nine studies involving 386 rodents were included. Meta-analysis demonstrated that acupuncture elevated the levels of 5-HT (SMD = 1.35), NE (SMD = 2.67), and DA (SMD = 1.43). Furthermore, acupuncture treatment was associated with increased ACh levels (SMD = 3.75) and enhanced synaptic plasticity, as evidenced by improved LTP (SMD = 4.75). Behavioral assessments revealed substantial cognitive improvements, indicated by a reduction in escape latency (SMD = -4.66) and an increased number of platform crossings (SMD = 3.00) in the Morris water maze test. Conclusion: Acupuncture may ameliorate cognitive impairment in VaD by modulating monoaminergic systems and enhancing synaptic plasticity. However, substantial heterogeneity and small sample sizes underscore the exploratory nature of these findings. To avoid overgeneralization of mechanistic pathways, further rigorous studies are essential. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD420251179267.
Gan et al. (Mon,) studied this question.