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Acupressure for Cognitive Impairment in Older Adults: What a New Meta-Analysis Tells Us

By Heather Davis, MS, RDN, LDN

Clinicians managing older adults face a recurring challenge: how to address cognitive decline, including depression, in patients already burdened by polypharmacy and comorbidities. A newly published systematic review and meta-analysis offers evidence that acupressure—a noninvasive, low-cost therapy rooted in traditional Chinese medicine—may meaningfully improve cognitive function and mood in older adults with cognitive impairment (CI). The study is described by its authors as the first meta-analysis to examine acupressure's effects on cognition, mood, and activities of daily living (ADLs) in this population. The findings have practical relevance for geriatricians, neurologists, and rehabilitation therapists seeking evidence-based nonpharmacological options for this growing patient group.1

Background
By 2030, an estimated 75 million people worldwide will be living with dementia; by 2050, that number is projected to reach approximately 130 million. Patients with CI commonly experience cognitive dysfunction alongside mood disturbances and impaired daily functioning, a combination that strains patients, caregivers, and health care systems. Pharmacological management is complicated because older adults with CI frequently carry other systemic diagnoses, and certain medications can worsen cognitive symptoms or cause adverse effects. Safe, effective nonpharmacological options are therefore a genuine clinical priority.1

Acupressure applies manual pressure via fingers, knuckles, or tools to specific acupuncture points along the body's “meridians.” It operates on the same theoretical foundation as acupuncture but requires no needles, carries no invasive risk, and can be performed by patients or caregivers after instruction. When applied correctly, it produces a soreness and swelling sensation known as "de qi," thought to convey its therapeutic effects. Several modalities exist, including Shiatsu, Jin Shin Do, auricular acupressure, and the Tapas acupressure technique.1

Study Design
Researchers searched eight databases, including PubMed, Embase, Cochrane Library, Web of Science, Sinomed, CNKI, Wanfang, and VIP, from inception through March 2025 with no language restrictions. From 296 initial articles, 14 randomized controlled trials (RCTs) met inclusion criteria and provided sufficient data for meta-analysis. The final sample included 1,101 older adults aged 60 to 91 years diagnosed with mild CI or Alzheimer's disease.

Trials came from mainland China (seven), Taiwan (three), Hong Kong (one), Vietnam (one), Italy (one), and Spain (one), published between 2012 and 2024. Sessions ranged from five to 60 minutes, administered one to three times daily, with total intervention periods spanning four weeks to 10 months. Eleven trials used acupressure alone; the remainder combined it with cognitive training, exercise, or aromatherapy. Control conditions included usual care, health education, drug treatment, exercise, aromatherapy, or no intervention.

Cognition
Five trials using acupressure as the primary intervention variable reported cognitive outcomes. Pooled analysis showed a statistically significant improvement favoring acupressure over controls (MD = 2.36; 95% CI, 1.71–3.00; P < 0.001; I² = 41.8%). Sensitivity analysis removing one outlying study reduced heterogeneity to 10.1% (MD = 2.09; 95% CI, 1.49–2.70), reinforcing the result's stability.

Subgroup analysis by intervention duration found the six-month subgroup produced the largest effect size (MD = 2.66), while the 10-month intervention yielded a smaller effect, possibly reflecting reduced patient adherence over prolonged periods. Two trials examining acupressure combined with cognitive therapy did not demonstrate a statistically significant cognitive advantage over cognitive therapy alone (SMD = 7.21; 95% CI, −4.75 to 19.16; P = 0.24), though extreme heterogeneity limits interpretation.

Agitation and Depression
Four trials reported agitation scores. Acupressure significantly reduced agitation compared with controls (MD = −1.51; 95% CI, −2.52 to −0.50; P = 0.003), with zero heterogeneity (I² = 0%), a notably consistent result.

Two trials measured depression using different validated instruments (the Cornell Scale for Depression in Dementia and the Geriatric Depression Scale). Pooled results showed a statistically significant reduction in depression with acupressure (SMD = −1.46; 95% CI, −2.26 to −0.66; P < 0.001; I² = 32.2%).

ADLs
Five trials assessed ADLs using the ADL scale, the Functional Activities Questionnaire, or the Modified Barthel Index. No statistically significant between-group difference was observed (SMD = 0.67; 95% CI, −0.11 to 1.46; P = 0.13), with very high heterogeneity (I² = 89.2%) and very low GRADE certainty. The authors suggest the null finding may reflect the fact that pooled studies primarily measured instrumental ADLs, which demands higher-order cognitive processing that acupressure may not sufficiently support.

Proposed Mechanisms
Acupoint stimulation is thought to increase cerebral blood flow, enhance oxygen and nutrient delivery to brain tissue, regulate nervous system excitability, and improve immune function. These processes may slow or partially reverse brain atrophy. Functional MRI research has demonstrated that long-term acupressure modulates primary somatosensory activity and brain plasticity. For mood outcomes, acupressure massage stimulates serotonin and beta-endorphin release. For agitation, acupressure may engage the hypothalamic-pituitary-adrenal axis to modulate cortisol production.1

Across the included studies, the three most frequently used acupoints were Baihui (GV20), Fengchi (GB20), and Taiyang (EX-HN5). No standardized protocol currently exists for acupressure in CI, and the authors suggest clinicians consider prioritizing these points while awaiting more definitive guidance.1

Limitations and Takeaways
Despite encouraging results, cautious optimism is warranted. The total sample of 1,101 patients across 14 trials is modest, and GRADE ratings of "low" and "very low" across all outcomes mean the true effects could differ meaningfully from the pooled estimates. The lack of standardized acupoint protocols across studies contributed to heterogeneity and makes direct comparisons difficult. The near-universal absence of follow-up assessments leaves unanswered questions about the durability of any benefit. Outcome measurement did not explore effects on specific cognitive subdomains such as executive function, working memory, or language.

Nonetheless, the practical appeal of acupressure is alluring. It is noninvasive, compatible with concurrent pharmacotherapy, can be self-administered by patients or performed by caregivers after professional instruction, and carries low cost and minimal risk. The authors call for multicenter RCTs stratified by cognitive stage and acupoint combination, along with neuroimaging studies to clarify central nervous system mechanisms. They also envision intelligent acupressure systems integrating pressure sensors with electroencephalogram feedback to enable individualized, dynamically optimized treatment protocols. For now, this meta-analysis provides a defensible evidence base for considering acupressure as a complementary—not replacement—strategy in the nonpharmacological management of CI in older adults.

— Heather Davis, MS, RDN, LDN, is editor of Today’s Geriatric Medicine.

Reference

1. Zhang H, Zhu L, Wu M, et al. Acupressure for older people with cognitive impairment: a systematic review and meta-analysis of randomized controlled trials. Front Psychiatry. 2025;16:1548878.