Aspirin falls short for prevention of dementia, AD

  • Neurology

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • Among cognitively healthy community-dwelling older adults, daily low-dose aspirin is not efficacious for dementia or Alzheimer disease (AD) prevention.

Why this matters

  • Dementia is increasing in prevalence, has considerable morbidity, and lacks effective treatments.
  • Editorial: "Aspirin therapy offers no protective effects for later-life cognition, cardiovascular disease, disability, or death.”

Key results

  • During median 4.7 years, 3.0% of participants received a dementia diagnosis (41% clinically probable AD).
  • No significant difference of aspirin vs placebo on risk (HRs; 95% CIs) for:
    • Diagnosed dementia: 0.98 (0.83-1.15).
    • Suspected dementia: 1.03 (0.91-1.17).
    • Clinically probable AD: 0.96 (0.74-1.24).
    • Mild cognitive impairment: 1.12 (0.92-1.37).
  • Aspirin and placebo groups had similar small changes in cognitive performance over time.

Study design

  • US and Australian randomized controlled trial among 19,114 community-dwelling adults age ≥70 years (US minorities, ≥65 years) free of cardiovascular disease, physical disability, diagnosed dementia (ASPREE trial).
  • Randomization: double-blind low-dose aspirin (100 mg daily) vs placebo.
  • Main outcome: adjudicated diagnosis of dementia according to DSM-IV criteria.
  • Funding: US National Institute on Aging; US National Cancer Institute; National Health and Medical Research Council of Australia; others.

Limitations

  • Incidences of dementia, mild cognitive impairment were lower than previously reported.
  • Aspirin dose, follow-up duration may have been insufficient.
  • Poor adherence by end of study.