PURPOSE: Recently, research on the management of Parkinson's disease (PD), particularly non-motor symptoms (NMS), has been increasingly reported. This systematic review and network meta-analysis (NMA) aimed to evaluate the efficacy of acupuncture interventions for NMS in PD patients to identify the most effective strategy. METHODS: Randomized controlled trials (RCTs) on acupuncture for NMS in PD were retrieved up to July 31, 2024, across eight databases: PubMed, Embase (OVID), Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database, and Wanfang Database. The quality of the included studies was assessed using the Cochrane handbook for systematic reviews. RESULTS: 77 RCTs were included, involving 5538 PD patients. The NMA indicated that acupuncture training usual ((SUCRA) 84.18%) was the best intervention for improving the anxiety state of PD patients. Abdominal_acupuncture_usual (94.15%) was a preferred intervention for improving the depressive state. Scalp acupuncture usual (99.98%) and Scalp electroacupuncture (94.28%) can significantly improve the sleep quality of PD patients. Heat sensitive moxibustion usual (94.65%) and Warm acupuncture moxibustion usual (99.995%) can significantly improve the quality of life of PD patients. Acupuncture usual (94.02%) may be considered a promising intervention for improving the psychological, emotional and cognitive functions. Additionally, shallow acupuncture usual (99.17%) was the safest option. Notably, acupuncture moxibustion (98.24%) was the most effective intervention involving the largest number of participants. CONCLUSION: This analysis identifies the most effective acupuncture interventions for improving NMS in PD patients, including anxiety, depression, sleep quality, and overall quality of life, as well as additional benefits in pain management and gastrointestinal function. Future large-scale RCTs are needed to confirm these findings.

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