by Nick Daniels, PharmD student
Dementia is one of the most prevalent health issues facing the elderly today. The disease state is characterized as a decline in memory or thinking skills severe enough to reduce a person’s ability to perform everyday activities.1 It is heavily correlated with Alzheimer’s in that 60 to 80% of those affected by the disease also suffer from dementia.1 One study estimates that 13.9%, which accounts for roughly 3.4 million people, of the population in the United States who are 71 years of age or older are affected by the disease with numbers increasing steadily as they progressed in age, with it ultimately effecting over 37% of the population older than 90.2 The severity of the symptoms associated with dementia, and its prevalence among the elderly, makes it a critical problem for which a preventative solution must be found.
The article, “Aspirin may Prevent Dementia and Cancers, World’s Largest Study Shows” published by ABC News discusses how researchers working in Australia are trying to do just that. The study, involving the participation of over 15,000 healthy Americans and Australians aged over 70, is using aspirin as a preventative agent to stop the development of the disease state through a suppression of stroke incidence.3 Researchers involved with the ASPREE study are using the aspirin in this case in an effort to keep constant the flow of blood to all areas in the brain in hopes of preventing tissue necrosis, microinfarcts, caused by ischaemic stroke.3 Tissue necrosis in the brain would result in reduced ability to think thereby causing advancement in dementia.3 Researchers began this double blind clinical trial in January of 2010 and they are expecting a reliable primary outcome measure by August of 2016.4 This sample is expected to be the most large scale available in regards to measuring aspirin preventative outcomes for dementia.5
While the aforementioned study into this area seems promising given the proven cardiovascular benefits of moderate aspirin usage and the study’s statistical power provided by its large sample size, I would advise caution to patients looking to dive headfirst into this type of preventative plan thinking it will be the guaranteed answer to solving the problem of dementia. To this point there is just not enough of a sample base to prove that the benefits of aspirin usage for the prevention of stroke outweigh the negatives, such as stomach bleeding and increased risk of massive stroke due to advanced movement of blood through the brain, associated with the medication.6 Hopefully the study currently being conducted can bring to light the answers to some of these questions. To this point, being so early on in the study, only the initial speculation by the researchers is available.
Without further evidence that validates the effectiveness of aspirin use in the prevention of dementia I cannot recommend its use for this indication. A previous study done by the NHMRC Psychiatric Epidemiology Research Centre in Australia tracking aspirin’s potential in use for preventing dementia actually found no difference between control and study groups.In cross-sectional data obtained in the study, those who had been taking NSAIDs or aspirin performed no better on the cognitive tests after account had been taken of other confounding variables.7
There are a few reasons behind the questionable results of some of these studies. The most important is they fail to acknowledge that stroke related dementia is only a portion of the larger problem of dementia as a whole.1 As was mentioned previously, up to 80% of all cases of dementia can be related to the development of Alzheimer’s which is different than the microinfarct dementia addressed by these studies.1 Many articles, like the one published by ABC, have the potential to heavily exaggerate the applicability of research being done. This could serve to mislead the public into adopting preventative strategies that could be ineffective, and at worst detrimental to their health. Also, the sample size in the NHMRC study is much smaller which could affect its validity in comparison to the larger study currently being conducted. Results from the larger study should give a more accurate representation of the medication’s effectiveness. I feel the ASPREE study also limits itself through a constrained diversity of ages. It would be more advantageous to begin the study using individuals who were much younger than 70 in order to reasonably ensure that patients had not already experienced some of the symptoms of dementia onset.
As health care professionals it is important to spread awareness in regards to dementia and the potential benefits, or shortcomings, of various preventative measures. Do you believe the limited base of evidence available for aspirin usage in the prevention of dementia is enough to warrant its use for this indication? What future do you believe the medication has in the prevention, or treatment, of neurodegenerative diseases?
 What is Dementia? Available at: http://www.alz.org/what-is-dementia.asp. Published June 28, 2013. Accessed December 2, 2013
 Plassman BL, Langa KM, Fisher GG, et al. Prevalence of dementia in the United States: the aging, demographics, and memory study. Neuroepidemiology. 2007;29(1-2):125-32
 Ogilvie, Felicity. Aspirin may Prevent Dementia and Cancers, World’s Largest Study Shows. ABC News. http://mobile.abc.net/news/2013-11-28/aspirin-may-prevent-dementia-cancers-world-largest-study-shows/5122836. Published November 28, 2013. Accessed December 3, 2013.
 Nelson M, http://clinicaltrials.gov/show/NCT01038583. Accessed December 6, 2013.
 ASPREE Study. Available at: http://www.aspree.org/AUS/aspree-content/aspree-study-details/about-aspree.aspx. Accessed December 6, 2013.
 Paikin JS, Eikelboom JW. Cardiology patient page: Aspirin. Circulation. 2012;125(10):e439-42.
 Henderson AS, Jorm AF, Christensen H, Jacomb PA, Korten AE. Aspirin, anti-inflammatory drugs and risk of dementia. Int J Geriatr Psychiatry. 1997;12(9):926-30.