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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.
Competing interests: None declared.