Over a 5-year period, average decline on the Mini Mental State Examination (MMSE) was −0.05 for women on low-dose aspirin compared with a decline of −0.95 for non-users, according to Anne Börjesson-Hanson, MD, and colleagues from the University of Gothenburg in Mölndal, Sweden.
And among those specifically at high cardiovascular risk, the decline also was less for aspirin users (−0.33 versus −0.95, P=0.028), the researchers reported online in a BMJ Open paper.
While low-dose aspirin has demonstrated benefits in the prevention of cardiovascular disease, studies on aspirin's effects on cognition and dementia have had contradictory findings.
In one double-blind trial, no effects on cognition were seen for aspirin use over 4 years in a cohort of healthy women, but a secondary analysis suggested the possibility of cognitive benefits among those with cardiovascular risks.
To further explore this, Börjesson-Hanson and colleagues conducted interviews and detailed medical
and neuropsychiatric examinations for 681 women in 2000.
Mean age was about 75, and the 10-year cardiovascular risk score was 22% according to the Framingham criteria, which defines high risk for a cardiovascular event as 10% or higher.
A total of 95% of the women were at high risk.
Although the American Heart Association recommends the use of low-dose aspirin by individuals at high risk, this is not the current practice in Sweden, and only 18.9% of women at baseline were taking aspirin.
At baseline, the aspirin users had lower MMSE scores and fared worse on word fluency tests.
But when the researchers looked at changes on MMSE for those who were taking aspirin at baseline and continued to do so when seen for follow-up 5 years later, they found an increase in score compared with women who had never been on aspirin (P=0.004).
About 14% of the women also were taking nonsteroidal anti-inflammatory agents (NSAIDs) other than aspirin, which have been reported to contribute to prevention of dementia, but no differences on MMSE scores were seen when NSAID users were compared with non-users.
Other tests of cognitive function such as the naming test and word memory also showed improvements among aspirin users, but the differences were not statistically significant.
There also were no differences between users and nonusers in other relevant outcomes:
- Dementia, 8.3% versus 8.4%, P=1.0
- Stroke, 7.1% versus 5.2%, P=0.438
- Gastric ulcer, 3.6% versus 8.9%, P=0.172
The mechanisms by which low-dose aspirin might confer benefits on cognition in the elderly are uncertain, but the researchers hypothesized that the drug's effects may relate to increasing blood flow to the brain through inhibition of platelet aggregation or by increasing the production of neuroprotective molecules known as docosanoids.
The authors concluded that low-dose aspirin appears to be helpful in maintaining cognitive function in elderly women who are at high cardiovascular risk, but noted that longer follow-up will be needed to fully determine the extent of the effect.
They also called for more basic science studies to clarify the specific mechanisms of aspirin in the brain.
Strengths of the study included its population-based, longitudinal design.
Limits included the observational design as well the possibility that confounding by indication may have occurred.
Another shortcoming was the reliance on the MMSE for cognitive assessments, because this test is not the most sensitive for detecting changes in executive functioning -- an area thought to be affected by aspirin.
The
study was supported by the Swedish Council for Working Life and Social
Research, the Alzheimer's Association Stehanie B. Overstreet Scholars,
the Swedish Research Council, the Brank of Sweden Tercentary Foundation,
Stiftelsen för Gamla Tjänarinnor and Handlanden Hjalmar Svenssons
Forskningsfond.
The authors reported no financial conflicts of interest.
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The authors reported no financial conflicts of interest.
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