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From the Department of Mental Hygiene (Drs. Zandi, Anthony, Mehta, Mayer, and Breitner, and K.M. Hayden), Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Banner Health System (Dr. Mayer), Phoenix, AZ; and VA Puget Sound Health Care System and Department of Psychiatry and Behavioral Sciences (Dr. Breitner), University of Washington, Seattle, WA.
Address correspondence and reprint requests to Dr. John Breitner, GRECC (S-182), VA Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108; e-mail: jcsb{at}u.washington.edu
Background: Previous analyses from the Cache County (UT) Study showed inverse associations between the prevalence of AD and the use of nonsteroidal anti-inflammatory drugs (NSAID), aspirin compounds, or histamine H2 receptor antagonists (H2RA). The authors re-examined these associations using data on incident AD.
Methods: In 1995 to 1996, elderly (aged 65+) county residents were assessed for dementia, with current and former use of NSAID, aspirin, and H2RA as well as three other "control" medication classes also noted. Three years later, interval medication histories were obtained and 104 participants with incident AD were identified among 3,227 living participants. Discrete time survival analyses estimated the risk of incident AD in relation to medication use.
Results: AD incidence was marginally reduced in those reporting NSAID use at any time. Increased duration of use was associated with greater risk reduction, and the estimated hazard ratio was 0.45 with 
2 years of exposure. Users of NSAID at baseline showed little reduction in AD incidence, regardless of use thereafter. By contrast, former NSAID users showed substantially reduced incidence (estimated hazard ratio = 0.42), with a trend toward greatest risk reduction among those with extended exposure. Similar patterns appeared with aspirin but not with any other medicines examined.
Conclusions: Long-term NSAID use may reduce the risk of AD, provided such use occurs well before the onset of dementia. More recent exposure seems to offer little protection. Recently initiated randomized trials of NSAID for primary prevention of AD are therefore unlikely to show effects with treatment until participants have been followed for several years.
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