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Risk of dementia in patients with non-haemorrhagic stroke receiving acupuncture treatment: a nationwide matched cohort study from Taiwan’s National Health Insurance Research Database
  1. Chun-Chuan Shih1,2,3,
  2. Chun-Chieh Yeh4,5,
  3. Chaur-Jong Hu6,
  4. Hsin-Long Lane1,
  5. Chin-Chuan Tsai1,
  6. Ta-Liang Chen7,8,9,
  7. Chien-Chang Liao7,8,9,10,11
  1. 1 School of Chinese Medicine for Post-Baccalaureate, College of Medicine, I-Shou University, Kaohsiung, Taiwan
  2. 2 Ph.D. Program for Clinical Drug Discovery from Botanical Herbs, Taipei Medical University, Taipei, Taiwan
  3. 3 Taipei Chinese Medical Association, Taipei, Taiwan
  4. 4 Department of Surgery, China Medical University Hospital, Taichung, Taiwan
  5. 5 Department of Surgery, University of Illinois, Chicago, Illinois, USA
  6. 6 Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
  7. 7 Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
  8. 8 Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  9. 9 Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
  10. 10 School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
  11. 11 Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
  1. Correspondence to Prof. Chien-Chang Liao; jacky48863027{at}


Objective To investigate the risk of dementia in patients with stroke who did and did not receive acupuncture treatment.

Design Retrospective cohort study.

Setting This study was based on Taiwan’s National Health Insurance Research Database that included patients with stroke hospitalised between 1 January 2000 and 31 December 2004.

Participants We identified 11 220 patients aged 50 years and older with newly diagnosed stroke hospitalisation.

Primary and secondary outcome measures We compared the incident dementia during the follow-up period until the end of 2009 in patients with stroke who did and did not receive acupuncture. The adjusted HRs and 95% CIs of dementia associated with acupuncture were calculated in multivariate Cox proportional hazard regressions.

Results Acupuncture treatment was associated with a decreased risk of dementia with multivariate adjustment (HR, 0.73; 95% CI 0.66 to 0.80), and the association was significant in both sexes and every age group, as well as in groups with ischaemic stroke, with fewer medical conditions and those hospitalised after stroke. Patients with stroke received acupuncture treatment, and conventional rehabilitation was associated with a significantly reduced risk of poststroke dementia (HR, 0.64; 95% CI 0.56 to 0.74).

Conclusions This study raises the possibility that patients with non-haemorrhagic stroke who received acupuncture had a reduced risk of dementia. The results suggest the need for prospective sham-controlled and randomised trials to establish the efficacy of acupuncture in preventing dementia.

  • Dementia
  • Stroke
  • acupuncture

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  • Contributors All the authors revised and approved the contents of the submitted article. C-CL and C-CS created the idea of the manuscript. C-CL and H-LL conducted statistical analysis of data. C-CS and C-CL wrote the manuscript. All the authors made substantial contributions to interpretation of data and carried out a critical revision of the manuscript for important intellectual content.

  • Contributors Prof. Ta-Liang Chen has equal contribution with the corresponding author

  • Funding This research was supported in part by Taiwan’s National Union of Chinese Medical Doctors’ Association (UNCMA104-H-001), Shuan Ho Hospital and Taipei Medical University (104TMU-SHH-23), Ministry of Science and Technology (MOST105-2629-B-038-001; MOST105-2314-B-038-025; MOST104-2314-B-038-027-MY2; MOST103-2320-B-214-010-MY2; NSC102-2314-B-038-021-MY3), the Committee on Chinese Medicine and Pharmacy, Department of Health, Taiwan (Grants nos. CCMP98-RD-038 and CCMP99-RD-035), and Taiwan’s Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW106-TDU-B-212-113004).

  • Competing interests None declared.

  • Patient consent To protect personal privacy, the electronic database was decoded with patient identification scrambled for further academic access for research. According to National Health Research Institutes regulations, informed consent is not required because of the use of decoded and scrambled patient identification.

  • Ethics approval This study was evaluated and approved by the Joint Institutional Review Board of Taipei Medical University (TMU-JIRB-201505055) and E-DA Hospital (EDA-JIRB-2014012).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data set available from the Taiwan’s National Health Research Institutes.