Recent studies indicate beneficial effects of acupuncture in the rehabilitation of vascular dementia (VaD). This study used 18-flourodeoxyglucose PET measures to compare cerebral effects of conventional acupuncture for hemiplegia with that of additional VaD-specific needling. As compared to baseline, conventional acupuncture increased glucose metabolism in the temporal lobe of unaffected and in the lentiform nucleus of the affected hemisphere. Additional needling in VaD-specific points rendered higher metabolism bilaterally in the frontal lobes and the thalamus, and in the temporal lobe and the lentiform nucleus of the unaffected hemisphere. The findings further underpin acupuncture's role in stroke and VaD rehabilitation.