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(anti-inflammatory medication, NSAIDs)
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Current Understanding: |
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The tables below summarize results from a modest number of reports that collectively show no association between use of non-steroidal anti-inflammatory drugs (NSAIDs) and the risk of Alzheimer disease dementia (AD) and total dementia. The results from observational studies are consistent with null findings from a randomized, double-blinded, placebo-controlled trial involving naproxen and celecoxib, which was halted early for safety concerns. While non-aspirin NSAID use (current, ever) assessed at the time of AD evaluation showed a protective association against AD risk, non-aspirin NSAID use assessed in years prior to AD evaluation showed no such association. Because by definition AD does not have an acute onset, but rather progresses over a number of years, the discrepancy in findings indicates that the time-updated analyses may not accurately reflect the association between NSAID use and AD risk. Studies that report time-updated results are particularly susceptible to bias from reverse causation, as individuals with cognitive decline may be less likely to be taking NSAIDs. Observational studies involving aspirin use show a marginally protective effect, although these results may be undermined by confounding by indication, healthy user bias, or selection bias. Because there are known risks to NSAID use, including cardiovascular events and gastrointestinal bleeding and ulceration, future studies examining the effect of NSAIDs by dose, duration, and timing on AD risk will likely be limited to observational studies. Because of these significant safety concerns and lack of evidence of any benefit, NSAID use is definitely not recommended to prevent AD. For a more in depth commentary, please see the Discussion. |
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