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• What is the primary question addressed by this study? Whether and how acupuncture change the hippocampal structure and function of SCD individuals? • What is the main finding of this study? Compared to sham acupuncture control, acupuncture improved the cognitive function of SCD individuals, increased hippocampal volume on the regional level and enhanced the structural and functional connectivity of hippocampus on the connective level. • What is the meaning of the finding? Our study provides empirical evidence demonstrating the cognitive benefits and multi-modal neurological mechanisms of acupuncture on SCD, attracting more attention to early cognitive intervention in the elderly. Converging evidence indicates that subjective cognitive decline (SCD) could be an early indicator of dementia. The hippocampus is the earliest affected region during the progression of cognitive impairment. However, little is known about whether and how acupuncture change the hippocampal structure and function of SCD individuals. Here, we used multi-modal MRI to reveal the mechanism of acupuncture in treating SCD. Seventy-two older participants were randomized into acupuncture or sham acupuncture group and treated for 12 weeks. At the end of the intervention, compared to sham acupuncture, participants with acupuncture treatment showed improvement in composite Z score from multi-domain neuropsychological tests, as well as increased hippocampal volume and functional connectivity. Moreover, the greater white matter integrity of the fornix, which is the major output tract of the hippocampus, was shown in the acupuncture group. These findings suggest that acupuncture may improve the cognitive function of SCD individuals, and increase hippocampal volume on the regional level and enhance the structural and functional connectivity of hippocampus on the connective level. [ABSTRACT FROM AUTHOR]