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BMJ. 2007 May 26; 334(7603): 1071.
PMCID: PMC1877885
Aspirin and Cognitive Decline

Too little, too late?

Richard J Prettyman, consultant old age psychiatrist

The study reported by Kang et al adds to the continuing debate about the usefulness (or lack thereof) of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) in preventing and treating cognitive decline in later life.1 The authors acknowledge the dose of aspirin used was insufficient to test a putative anti-inflammatory mechanism of action and would therefore be likely only to detect possible benefit resulting from platelet inhibition; an additional major consideration mentioned only briefly in their discussion is that of the timing of the relation between either platelet aggregation or inflammatory mechanisms to the onset and progression of cognitive decline.

Many of the observational studies of NSAIDs reporting associations between use of these drugs and reduced rates of cognitive decline2 3 4 included subjects with long periods of exposure to these drugs in mid-adult life. This is increasingly recognised as the period during which neurodegenerative processes may become established.5 The potential of these agents for primary prevention of cognitive decline will remain unknown until we have seen the results of intervention studies involving younger adults.

Notes

Competing interests: None declared.

References

1. Kang JH, Cook N, Manson J, Buring JE, Grodstein F. Low dose aspirin and cognitive function in the women's health study cognitive cohort. BMJ 2007;334:987-90. (12 May.) [PMC free article] [PubMed]
2. Stewart WF, Kawas C, Corrada M, Metter EJ. Risk of Alzheimer's disease and duration of NSAID use. Neurology 1997;48:626-32. [PubMed]
3. Bas A, Veld MD, Ruitenberg A, Hofman A, Launer LJ, Van Duijn CM, et al. Nonsteroidal anti-inflammatory drugs and the risk of Alzheimer's disease. N Engl J Med 2001;345:1515-20. [PubMed]
4. Jonker C, Comijs HC, Smit JH. Does aspirin or other NSAIDs reduce the risk of cognitive decline in elderly persons? Results from a population-based study. Neurobiol Aging 2003;24:583-8. [PubMed]
5. Braak E, Griffing K, Arai K, Bohl J, Bratzke H, Braak H. Neuropathology of Alzheimer's disease: what is new since A. Alzheimer? Eur Arch Psychiatry Clin Neurosci 1999;249(suppl 3):14-22.

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