Inspired by Liao et al 2024.[1]
RA – rheumatoid arthritis
AD – Alzheimer’s disease
MCI – mild cognitive impairment
aHR – adjusted hazard ratio
RR – risk ratio
CHD – coronary heart disease
FM – fibromyalgia
RCIPD – Registry for the Catastrophic Illness Patient Database (Taiwan)
NHIRD – National Health Insurance Research Database (Taiwan)– key to acronyms
This is yet another large retrospective cohort trial from Taiwan. There has been a paper published from a group in Taiwan on dementia risk every year for the past 4 years, making this the 4th in my records that examines the dementia risk in different conditions. I have highlighted each one individually on this blog, and will include the individual links below, but all are listed under the category: AD and MCI.
In 2021, we saw a reduced risk of dementia in stroke patients who received acupuncture (aHR 0.48) – see: Post-stroke dementia.[2]
In 2022, we saw a reduced risk of dementia in migraine patients who received acupuncture (aHR 0.51) – see: Acupuncture and dementia risk in migraine.[3]
In 2023, we saw a reduced risk of dementia in patients with insomnia who received acupuncture (aHR 0.54) – see: Acupuncture and dementia risk in insomnia.[4]
This year, a group led by Professor Hung-Rong Yen returned to the condition that first caught my attention in this type of research in 2018 (RA) – see: CHD incidence in RA and acupuncture.[5] I had overlooked the very first such paper examining CHD incidence in FM the previous year.[6]
This study used the RCIPD, part of the NHIRD, to find all the new diagnoses of RA between 2000 and 2010 (n=30 454). After necessary exclusions they had 9 919 acupuncture users and 19 331 non-users. Acupuncture users tended to be younger and more female than non-users. Subsequent propensity score matching reduced the final cohorts to 9 218 each.
After propensity score matching, the mean age of each cohort was identical (52.7 years) but the distribution was slightly different, with slightly more patients in both younger (18-39) and older (≥60) categories in the acupuncture user cohort, and fewer in the middle category (40-59).
By the end of the follow up period (2011) there were 546 cases of dementia. 215 in the acupuncture user cohort and 331 in the non-user cohort. This gave an aHR of 0.55 associated with acupuncture use, although given identical sized cohorts, these figures look more like they should give a crude RR of 0.65. I have asked Professor Hung-Rong Yen about this and will report back.
I was interested to see that the lowest aHR (0.27) was associated with use of NSAIDs, but before you start recommending NSAIDs to your RA patients to reduce the incidence of dementia, note that a prospective trial of NSAIDs in AD was stopped early due to excess cardiovascular events.[7] Subsequent analysis revealed that the effect of NSAIDs varied depending on the stage of the disease.[8]
Addendum re RR vs HR
I decided to ask ChatGPT to explain the difference between RR and HR… I was very impressed with the explanation! In brief RR does not account for time but HR does. See the long version here.
References
1 Liao H-H, Huang M-C, Lee Y-C, et al. Acupuncture treatment is associated with a decreased risk of dementia in patients with rheumatoid arthritis in Taiwan: A propensity-score matched cohort study. Integr Med Res. 2024;13:101086. doi: 10.1016/j.imr.2024.101086
2 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
3 Huang C-H, Lin M-C, Chou I-C, et al. Acupuncture Treatment is Associated with Reduced Dementia Risk in Patients with Migraine: A Propensity-Score-Matched Cohort Study of Real-World Data. Neuropsychiatr Dis Treat. 2022;18:1895–906. doi: 10.2147/NDT.S372076
4 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
5 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
6 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
7 ADAPT Research Group, Meinert CL, McCaffrey LD, et al. Alzheimer’s Disease Anti-inflammatory Prevention Trial: design, methods, and baseline results. Alzheimers Dement. 2009;5:93–104. doi: 10.1016/j.jalz.2008.09.004
8 Breitner JC, Baker LD, Montine TJ, et al. Extended results of the Alzheimer’s disease anti-inflammatory prevention trial. Alzheimers Dement. 2011;7:402–11. doi: 10.1016/j.jalz.2010.12.014
The BMAS Blog 
You must be logged in to post a comment.