1. Prescription Pattern of Chinese Herbal Products for Alzheimer's Disease in Taiwan: a Population-based study 1.Department of Chinese Medicine, Taipei City Hospital, Ren-Ai Branch 2.Department of Chinese Medicine, Taipei City Hospital, Yang-Ming Branch 3Department of Neurology, Taipei City Hospital, Ren-Ai Branch Figure1 Flowchart of recruitment from the 1-million random sample of the NHIRD Table 3 Potential effects of the herbs contained in the ten most common herbal formulae prescribed by TCM doctors for treating Alzheimer’s disease CharacteristicsTCM a non-usersTCM users aOR (95% CI ) No. of cases248889 Age at diagnosis(Incidence Rate) <45 (0.001%) 27 0.78(0.15-4.05) 45-54 (0.036%) 227 3.64(0.80-16.53) 55-64 (0.246%) 27115 1 65-74 (1.185%) 92309 0.74(0.45-1.22) 75-84 (7.105%) 107381 0.83(0.51-1.36)  85 (17.942%) 1850 0.61(0.30-1.24) Mean years73.872.8 Gender female (0.13%) 121530 1.57(1.16-2.13) Male (0.10%) 127359 1 Insured region Taipei city 61137 1 Kaohsiung city 1471 2.38(1.24-4.57) Northern Taiwan 58200 1.65(1.07-2.54) Middle Taiwan 322093.00(1.83-4.90) Southern Taiwan 78240 1.39(0.91-2.12) Eastern Taiwan 421 2.48(0.80-7.64) Outlying island 111 4.98(0.61-40.51) Numbers of anti-Alzheimer's drugs 1 828 1 2 51145 0.81(0.35-1.90) 3 87318 1.04(0.46-2.37) ≥4 102398 1.12(0.49-2.52) Table 1 Demographic characteristics and multiple logistic regression of patient with newly diagnosed Alzheimer's disease from 1997 to 2008 in Taiwan. ABSTRACT This study is the first random national-level sample to document the usage characteristics of traditional Chinese medicine in Alzheimer’s disease (AD) patients between 1997 and 2008. The Chinese herbal product (CHPs) usage prescribed for AD was evaluated using a cohort of National Health Insurance Research Database in Taiwan. We used logistic regression to estimate the odds ratios for using traditional Chinese medicine (TCM). Our results showed 78.2% of patients with AD utilized TCM. Women and those aged 55-65 years were more likely to be TCM users than men and other age groups. The results also demonstrate that people with AD who are living in urban areas and have developed more behavioral and psychological symptoms of dementia were more likely to be TCM users. People with AD tended to use CHPs to manage AD symptoms and side effects of anti-AD drugs. Ma-Zi-Ren-Wan and Bu-Zhong-Yi-Qi-Tang are the 2 most frequently prescribed formulae. Major disease category Number of visits (%) Chinese herbal Acupuncture, or Manipulative therapies Total of TCM Infectious and parasitic diseases42(0.2%)5(0.0%)47(0.2%) Neoplasms119(0.5%)0(0.0%)119(0.5%) Endocrine, nutritional, blood and metabolic diseases, and immunity disorders 799(3.2%)25(0.1%)824(3.3%) Mental disorders & nervous system Diseases1901(7.7%)389(1.6%)2290(9.3%) Alzheimer’s disease693(2.8%)217(0.9%)910(3.7%) Behavioral and Psychological Symptoms of Dementia 519(2.1%)19(0.1%)538(2.2%) Diseases of the circulatory system1006(4.1%)162(0.7%)1168(4.7%) Diseases of the respiratory system3449(13.9%)93(0.4%)3542(14.3%) Diseases of the digestive system2954(11.9%)70(0.3%)3024(12.2%) Diseases of the genitourinary system789(3.2%)40(0.2%)829(3.4%) Diseases of the skin and subcutaneous tissue327(1.3%)9(0.0%)336(1.4%) Diseases of musculoskeletal and connective tissue 2016(8.2%)2946(11.9%)4962(20.1%) Symptoms, signs, and ill-defined conditions3877(15.7%)1134(4.6%)5011(20.3%) Injury and poisoning77(0.3%)852(3.4%)929(3.8%) Others * 322(1.3%)848(3.4%)1170(4.7%) Total18138(73.3%)6613(26.7%)24751(100.0%) Table 2. Frequency distribution of TCM visits by major disease categories in Alzheimer's patients Herbal Formulae Contain drug Ma-Zi-Ren-Wan †§§ Cannabis Fructus, Rhei Radix et Rhizoma §, Paeoniae Radix Alba †, Aurantii Fructus Immaturus, Magnoliae Officinalis Cortex, Armeniacae Semen § Bu-Zhong-Yi-Qi- Tang †‡§ ‖§ Astragali Radix Cruda,Ginseng Radix †‡§ ‖, Glycyrrhizae Radix cum Liquido Fricta, Atractylodis MacrocephalaeRhizoma, Angelicae Sinensis Radix Integra †§ ‖, CitriReticulatae Pericarpium, Cimicifugae Rhizoma, Bupleuri Radix, Zingiberis Rhizoma Recens, Jujubae Fructus§ Ji-Sheng-Shen-Qi- Wan †§§ Rehmanniae Radix, Poria cum †§, Corni Fructus, Dioscoreae Rhizoma, Moutan Cortex, Alismatis Rhizoma, Aconiti Radix Lateralis, Cinnamomi Cortex, Achyranthis Bidentatae Radix, Plantaginis Semen§ Tian-Wang-Bu-Xin- Dan †‡§ ‖§ Rehmanniae Radix,Ginseng Radix †‡§ ‖, Polygalae Radix §, Scrophulariae Radix, Platycladi Semen, Platycodonis Radix, Asparagi Radix, Salviae Miltiorrhizae Radix §, Ziziphi Spinosi Semen, Ophiopogonis Radix, Poria cum PiniRadice †§, Angelicae Sinensis Radix Integra †§ ‖, Schisandrae Fructus§ Gan-Mai-Da-Zao- Tang Glycyrrhizae Radix Cruda,Jujubae Fructus, Tritici Semen Sheng-Mai-San †‡§ ‖§ Ginseng Radix †‡§ ‖,Ophiopogonis Radix,Schisandrae Fructus§ Tian-Ma-Gou-Teng- Yin †§§ Gastrodiae Rhizoma §, Uncariae Ramulus cum Uncis †, Haliotidis Concha, Gardeniae Fructus, Scutellariae Radix, Eucommiae Cortex, Loranthiseu Visci Ramus, LeonuriHerba, PolygoniMultiflori Caulis,Achyranthis Bidentatae Radix,Poria cum Pini Radice †§ § Liu-Wei-Di-Huang- Wan § § Rehmanniae Radix, Poria cum §, CorniFructus, DioscoreaeRhizoma, Moutan Cortex, AlismatisRhizoma § Qi-Bao-Mei-Ran- Dan †§ ‖§ PolygoniMultiflori Radix,AchyranthisBidentatae Radix,AngelicaeSinensis Radix Integra †§ ‖, Poria cum, Cuscutae Semen, LyciiFructus, PsoraleaeFructus§ Tao-Hong-Si-Wu- Tang †§ ‖§ Persicae Semen, Carthamustinctorius Flos,, Angelicae Sinensis Radix Integra †§ ‖, Chuanxiong Rhizoma,Paeoniae Radix Alba †, Rehmanniae Radix§ † Formulae contained single herb might promote the neurotransmitter acetylcholine. ‡ Formulae contained single herb might inhibit the NMDA) receptor § § Formulae contained single herb might reduce the β-amyloid ‖,Formulae contained single Herb might decrease the Tau protein Shun-Ku Lin 1, Jung-Nien Lai 2, Sui-Hing Yan 3 Table 3 Potential effects of the herbs contained in the ten most common herbal formulae