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Cheng-Hao Huang,1,2 Mei-Chen Lin,3,4 I-Ching Chou,5,6 Ching-Liang Hsieh2,7,8 1Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung City, 40402, Taiwan; 2Department of Chinese Medicine, China Medical University Hospital, Taichung City, 40447, Taiwan; 3Management Office for Health Data, China Medical University Hospital, Taichung, 40447, Taiwan; 4College of Medicine, China Medical University, Taichung, 40402, Taiwan; 5School of Chinese Medicine, China Medical University, Taichung City, 40402, Taiwan; 6Division of Pediatric Neurology, China Medical University Children’s Hospital, Taichung City, 40447, Taiwan; 7Chinese Medicine Research Center, China Medical University, Taichung City, 40402, Taiwan; 8Graduate Institute of Acupuncture Science, China Medical University, Taichung City, 40402, TaiwanCorrespondence: Ching-Liang Hsieh, Graduate Institute of Acupuncture Science, China Medical University, 91 Hsueh-Shih Road, Taichung, 40402, Taiwan, Tel +886-4-22053366 ext. 3128, Fax +886-4-22037690, Email clhsieh@mail.cmuh.org.twBackground: Migraine is a recurrent headache disease that has been identified as a risk factor for subsequent dementia. The present study collected data from Taiwan’s National Health Insurance Research Database (NHIRD) to investigate the incidence of dementia in patients with migraine who did or did not concurrently receive acupuncture treatment.Methods: A 1:1 propensity score method was used to match an equal number of patients (N = 4813) in the acupuncture and nonacupuncture cohorts based on sex, age, migraine diagnosis year, index year, insurance amount, urbanization level, baseline comorbidities, and medication usage. We employed Cox proportional hazards models to evaluate the risk of dementia.Results: Patients with migraine who received acupuncture treatment were found to have a lower risk of dementia (adjusted hazard ratio [aHR] = 0.51, 95% CI = 0.40– 0.65) than those who did not undergo acupuncture treatment. The cumulative incidence of dementia was significantly lower in the acupuncture cohort than in the nonacupuncture cohort (Log rank test, p < 0.001). This propensity score–matched cohort study demonstrated an association between acupuncture treatment and dementia development in patients with migraine in Taiwan.Conclusion: The results suggest that acupuncture treatment significantly reduced the development of dementia in patients with migraine.Keywords: acupuncture, migraine, dementia, National Health Insurance Research Database, NHIRD, propensity score, cohort

Kuan-Yu Chen,1 Ming-Cheng Huang,2,3 Cheng-Li Lin,4 Yu-Chen Lee,2,3,5 Mei-Yao Wu,2,6,&ast; Hung-Rong Yen2,3,7– 9,&ast; 1Department of Chinese Medicine, Taipei City Hospital, Yangming Branch, Taipei, Taiwan; 2Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan; 3Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; 4Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; 5Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan; 6School of Post-Baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; 7Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; 8Chinese Medicine Research Center, China Medical University, Taichung, Taiwan; 9Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan&ast;These authors contributed equally to this workCorrespondence: Hung-Rong YenGraduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, 91 Hsueh-Shih Road, North District, Taichung, 404328, TaiwanTel +886-4-22053366 ext. 3001Fax +886-4-22365141Email hungrongyen@mail.cmu.edu.twMei-Yao WuSchool of Post-Baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, 91 Hsueh-Shih Road, North District, Taichung, 404328, TaiwanTel +886-4-22052121 ext. 4561Fax +886-4-22037690Email meiyaowu0919@gmail.comBackground: Depression is one of the most disabling disorders, which causes long-term complications such as neurodegenerative disorder and cerebrovascular disease. Some patients with depression seek acupuncture treatment. We aimed to investigate the association between acupuncture treatment and the risk of dementia in patients with depression from the perspective of real-world evidence.Methods: Patients over 18 years old and newly diagnosed with depression between 1997 and 2010 were selected from the Taiwanese National Health Insurance Research Database and followed up until the end of 2013. Propensity score was used to match equal numbers of patients 1:1 (N = 16,609 per group) into acupuncture and non-acupuncture cohorts based on characteristics including sex, age, baseline comorbidity and drug use. The outcome measurement was the comparison of dementia incidence in the two cohorts.Results: Compared with the non-acupuncture cohort, patients who received acupuncture treatment had a decreased risk of dementia (adjusted hazard ratio (aHR) = 0.54; 95% confidence interval (CI) = 0.50– 0.58, P < 0.001) after adjustment for age, sex, comorbidities and drug use. Compared with depression patients who did not receive acupuncture, the aHR of vascular dementia and Alzheimer’s disease incidences for patients who had acupuncture therapy was 0.59 (95% CI 0.48– 0.71) and 0.51 (95% CI 0.39– 0.67), respectively. The cumulative incidence of dementia was significantly lower in the acupuncture cohort than in the non-acupuncture cohort (Log rank test, p < 0.001).Conclusion: The present study from real-world data revealed that acupuncture reduced the risk of dementia in depression patients, which supports healthcare decisions in clinical practice.Keywords: acupuncture, Alzheimer’s disease, depression, dementia, National Health Insurance Research Database, NHIRD, traditional Chinese medicine