Acupuncture and dementia risk in insomnia 2023

Inspired by Huang et al 2023.[1]

WHO – World Health Organisation
PRC – Peoples Republic of China
LHID – Longitudinal Health Insurance Database
NHIRD – National Health Insurance Research Database (Taiwan)
HR – hazard ratio
aHR – adjusted hazard ratio
NSAID – non-steroidal anti-inflammatory drug
MAOI – monoamine oxidase inhibitor
SSRI – selective serotonin reuptake inhibitor

key to acronyms

I have been sitting on this reference for a few months as I was not able to get hold of the full text until more recently. I think this is the first paper I have highlighted in the Journal of Traditional and Complementary Medicine. This journal has been around since 2011 and now has an impact factor of 4.5. It refers to itself as eJTCM and the majority of its 149 editors come from Taiwan.

I first came across the phrase traditional and complementary medicine (T&CM) in a WHO strategy document in 2014, which had been financed by the PRC. Prior to that the WHO had used the phrase traditional, complementary, and alternative medicine, and farther back they simply referred to traditional medicines. The current favoured phrase by the WHO is traditional, complementary, and integrative medicine and is referred to as TCI, but T&CM still features quite a lot on their website and in their publications.

This paper is another of the large retrospective cohort studies from Taiwan and it comes from the same group that brought us Acupuncture and dementia risk in migraine 2022.

This time they included 152 585 patients from the LHID (a subset of the NHIRD) newly diagnosed with insomnia between 2000 and 2010. To be included each patient had to have had at least 2 outpatient visits or 1 episode of inpatient care with an insomnia diagnosis. 18 782 of the cohort had received at least 6 sessions of acupuncture following the diagnosis of insomnia and each was matched with a patient who did not receive acupuncture by using propensity score matching. The matching variables, as always, included age, sex, insurance amount, urbanisation level, comorbidities, and related medications. Use of NSAIDs and steroids were also included because it has been suggested that their use may influence the onset of dementia.

So, having at least 6 acupuncture sessions following a diagnosis of insomnia was associated with a reduced risk of dementia (aHR 0.54). The mean number of acupuncture sessions was 19.1, although it is difficult to know over what time period these were distributed. The entire period of the study was 13 years, so it had to be less than that.

I was surprised to see that use of NSAIDs was associated with an even larger reduction in risk of dementia (aHR 0.34) and oral steroids and statins were associated with more modest reductions in risk (aHR ~0.70). In the case of statins, the reduced risk appears greater than the increased risk associated with hyperlipidaemia as a comorbidity, so if these were causal relationships then we would have to consider that statins have other effects than simply altering lipids.

Increased risks were associated with the use of MAOIs and SSRIs but not with tricyclic antidepressants – again, an interesting observation.

Reference

 1         Huang C-H, Lin S-K, Lin M-C, et al. Acupuncture is associated with reduced dementia risk in patients with insomnia: A propensity-score-matched cohort study of real-world data. J Tradit Complement Med 2023;13:297–305. doi:10.1016/j.jtcme.2023.02.003