Aspirin in Dementia - Cognitive Decline

Professor Peter Elwood, of the Medical Research Council Unit in Wales, has highlighted the possibility that aspirin may help people with dementia.

The rationale for aspirin in dementia is fairly obvious in "vascular" or "multi-infarct" where the pathology is the same as for coronary heart disease. The problems is the progressive blocking of the arteries in the brain by multiple plugs of aggregated platelets, so that aspirin should have a substantial effect on the disease.

One trial in such patients has been reported, by Meyer et al. Seventy patients selected for their high risk of vascular dementia were given either 325 mg aspirin a day or no drug. The aspirin group scored significantly better on cognitive performance at each of the three annual follow up examinations than the controls. The aspirin patients, but not the controls, were stated to have improved their activities of daily living, and to have become less dependent on others.

This type of vascular dementia is said to affect, to some degree, one quarter of people over 70 years old. However, there is some reason to believe that aspirin may also help people with the more common form of dementia, Alzheimer's disease.

Alzheimer's disease is claimed to be an inflammatory disease of the brain, similar to that of rheumatoid disease of the joints, and the American doctors who make the claim, Drs Joe Rogers and Pat McGeer, suggest that patients be treated with NSAIDs. The records of 12,000 patients who had either Alzheimer's disease or rheumatoid arthritis showed that a much smaller number of them than expected had both diseases. British doctors have made the same observation. One explanation for this is that the anti-inflammatory drugs given over many years for rheumatoid disease has prevented the changes of Alzheimer's.

Which leads us back to Professor Elwood. He has organised a prospective, randomised, double blind, placebo controlled trial of aspirin 100mg daily in men drawn from his Caerphilly Cohort Study, which started in 1979. He already has very extensive information on them, their health and lifestyles, and many other factors that may be important to their possible development of dementia. He intends to include 400 men in the trial, and patients were still being entered this year. The results are not expected for ten years - but they will surely help to guarantee interest in aspirin well into its second century!