Post-stroke dementia

Stimulated by Chu et al 2021.[1]

Photo by Steven HWG on Unsplash.

LHID – Longitudinal Health Insurance Database (Taiwan)
NHIRD – National Health Insurance Research Database (Taiwan)
CCI – Charlson Comorbidity Index
HR – hazard ratio

key to acronyms

We all know that dementia is fast becoming one of the biggest health and social care challenges of our era, and the numbers affected worldwide are projected to reach 75 million by 2030 and 132 million by 2050.[2,3] The annual global cost of caring for people with dementia was in excess of 800 billion US dollars in 2015 and is set to reach 2 trillion dollars by 2030, that is around 20 times the current annual cost of the UK NHS.

According to the Global Burden of Diseases study,[4] the disability-adjusted life years (DALYs) resulting from dementia have increased by almost 40% from 2007 to 2017. For comparison, DALYs related to all non-communicable diseases increased by an average of 16% over the same period, and those related to communicable diseases fell by over 26%. Type 2 diabetes came in at 34% up.

The paper I am highlighting this week is another large retrospective cohort study from Taiwan. It used the LHID2000, which is composed of a random selection of 1 million people from the NHIRD, and is the oldest of the 3 current LHIDs. Details of these subsets of the NHIRD can be found here:

Chu et al included 9 547 patients receiving ambulatory or hospital care for stroke and matched them for sex, age and CCI with a further 9 547 non-stroke patients.

For details on the CCI see the blog from 21 Aug 2019: Can acupuncture prevent neck surgery?

Each patient was tracked for 3 years from their index use of healthcare for stroke, or the matched date for the non-stroke patients, and the number diagnoses with dementia were noted. The stroke group were further subdivided based on their use of acupuncture into 2 449 who received acupuncture and 7 098 who did not.

Stroke is associated with 3 times the risk of developing dementia

The risk of developing dementia within 3 years of stroke (adjusted HR) was 3.239 compared with the matched non-stroke cohort.

In the stroke cohort, receiving acupuncture was associated with a 50% reduction in the rate of dementia in the following 3 years (adjusted HR 0.482).

50% reduction in the rate of post-stroke dementia associated with acupuncture

A 50% reduction in the rate of post-stroke dementia would constitute a huge saving in health and social care costs. Moreover, previous large retrospective cohorts have indicated a reduction on stroke risk associated with acupuncture in fibromyalgia and in depression.

Whilst these are very encouraging findings, we do need prospective research to confirm that these associations have a cause-and-effect relationship before proposing a dramatic role out of acupuncture provision.

If we review the findings of these retrospective cohorts up to now, and if they all proved subsequently to have indicated cause-and-effect relationships, we would be considering acupuncture treatment for all patients with the following:

  • Fibromyalgia (reduced risk of coronary artery disease and stroke)[5,6]
  • Rheumatoid arthritis (reduced risk of coronary artery disease)[7]
  • Depression (reduced risk of stroke and Parkinson’s disease)[8]
  • Neck pain (reduced surgical interventions)[9]
  • Knee osteoarthritis (reduced surgical interventions)[10]
  • Hypertension (reduced major adverse cardiovascular events)[11]
  • Surgery for hip fracture (reduced mortality, readmission and reoperation)[12]
  • Osteoarthritis (reduced coronary artery disease)[13]
  • Shoulder pain (reduced acromioplasty)[14]

That would keep us acupuncturists busy for a while!


1          Chu S-A, Chen T-Y, Chen P-Y, et al. Acupuncture May Decrease the Incidence of Post-stroke Dementia: A Taiwan Nationwide Retrospective Cohort Study. Front Neurol 2021;12:657048. doi:10.3389/fneur.2021.657048

2          Frankish H, Horton R. Prevention and management of dementia: a priority for public health. Lancet 2017;390:2614–5. doi:10.1016/S0140-6736(17)31756-7

3          Prince M, Wimo A, Guerchet M, et al. World Alzheimer Report 2015: The global impact of dementia: An analysis of prevalence, incidence, cost and trends. Published Online First: 21 September 2015. (accessed 13 Jun 2021).

4          GBD 2017 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1859–922. doi:10.1016/S0140-6736(18)32335-3

5          Wu M-Y, Huang M-C, Chiang J-H, et al. Acupuncture decreased the risk of coronary heart disease in patients with fibromyalgia in Taiwan: a nationwide matched cohort study. Arthritis Res Ther 2017;19:37. doi:10.1186/s13075-017-1239-7

6          Huang M, Yen H-R, Lin C, et al. Acupuncture decreased the risk of stroke among patients with fibromyalgia in Taiwan: A nationwide matched cohort study. PLOS ONE 2020;15:e0239703. doi:10.1371/journal.pone.0239703

7          Wu M-Y, Huang M-C, Liao H-H, et al. Acupuncture decreased the risk of coronary heart disease in patients with rheumatoid arthritis in Taiwan: a Nationwide propensity score-matched study. BMC Complement Altern Med 2018;18:341. doi:10.1186/s12906-018-2384-5

8          Huang C-H, Lin M-C, Hsieh C-L. Acupuncture Treatment Reduces Incidence of Parkinson’s Disease in Patients With Depression: A Population-Based Retrospective Cohort Study in Taiwan. Front Aging Neurosci 2020;12:591640. doi:10.3389/fnagi.2020.591640

9          Han D, Koh W, Shin J-S, et al. Cervical surgery rate in neck pain patients with and without acupuncture treatment: a retrospective cohort study. Acupunct Med Published Online First: August 2019. doi:10.1136/acupmed-2018-011724

10        Gang B-G, Shin J-S, Lee J, et al. Association Between Acupuncture and Knee Surgery for Osteoarthritis: A Korean, Nationwide, Matched, Retrospective Cohort Study. Front Med 2020;7:524628. doi:10.3389/fmed.2020.524628

11        Jung H, Yeo S, Lim S. Effects of acupuncture on cardiovascular risks in patients with hypertension: a Korean cohort study. Acupunct Med Published Online First: June 2020. doi:10.1177/0964528420920290

12        Lin JC-F, Lin T-C, Cheng C-F, et al. Lower rates of mortality, readmission and reoperation in patients receiving acupuncture after hip fracture: a population-based analysis. Acupunct Med 2020;:096452842091166. doi:10.1177/0964528420911664

13        Ton G, Yang Y-C, Lee L-W, et al. Acupuncture Decreased the Risk of Coronary Heart Disease in Patients with Osteoarthritis in Taiwan: A Nationwide Matched Cohort Study. J Altern Complement Med 2020;18:acm.2020.0153. doi:10.1089/acm.2020.0153

14        Yang G, Jung B, Kim M-R, et al. Acromioplasty rates in patients with shoulder disorders with and without acupuncture treatment: a retrospective propensity score-matched cohort study. Acupunct Med 2020;38:255–63. doi:10.1177/0964528419895529

Declaration of interests MC