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Published online before print April 22, 2009, doi:10.1212/WNL.0b013e3181a18691)
© 2009 American Academy of Neurology Risk of dementia and AD with prior exposure to NSAIDs in an elderly community-based cohortFrom the Geriatric Research Education and Clinical Center (J.C.S.B.), Department of Veterans Affairs Medical Center, Seattle; University of Washington School of Medicine (J.C.S.B., P.K.C.), Seattle; Center for Health Studies (S.J.P.A.H., R.W., S.D., E.B.L.), Group Health Cooperative, Seattle; Department of Epidemiology (S.D.), University of Washington School of Public Health and Community Medicine, Seattle; and University of Washington School of Pharmacy (S.L.G.), Seattle. Address correspondence and reprint requests to Dr. Breitner, GRECC (S-182), VA Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108 jcsb{at}u.washington.edu Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) may prevent Alzheimer dementia (AD).
Methods: We analyzed the association of prior NSAID exposure with incident dementia and AD in the Adult Changes in Thought population-based cohort aged Results: Pharmacy records identified 351 participants (12.8%) with history of heavy NSAID use at enrollment. Another 107 became heavy users during follow-up. Some 476 individuals developed incident dementia, 356 with AD (median onset ages 83.5 and 83.8 years). Contrary to the hypothesis that NSAIDs protect against AD, pharmacy-defined heavy NSAID users showed increased incidence of dementia and AD, with adjusted hazard ratios of 1.66 (95% confidence interval, 1.24–2.24) and 1.57 (95% confidence interval, 1.10–2.23). Addition of self-reported exposure data did not alter these results. Conclusions: These findings differ from those of other studies with younger cohorts. The results observed elsewhere may reflect delayed onset of Alzheimer dementia (AD) in nonsteroidal anti-inflammatory drug (NSAID) users. Conceivably, such delay could result in increased AD incidence in late old age. The relation of NSAID use and AD pathogenesis needs further investigation. ACT = Adult Changes in Thought; AD = Alzheimer dementia; ADL = activities of daily living; aHR = adjusted hazard ratio; CI = confidence interval; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th edition; GH = Group Health; HR = hazard ratio; NSAID = nonsteroidal anti-inflammatory drug; OR = odds ratio; SDD = standard daily dose.
Received October 20, 2008. Accepted in final form January 26, 2009. Supplemental data at www.neurology.org Editorial, page 1884 e-Pub ahead of print on April 22, 2009, at www.neurology.org. *These authors contributed equally. Supported by the US Department of Veterans Affairs and NIH Grants U01-AG-06781, R01-AG-24010, U01-AG-15477, and K23-AG-28954 (Paul Beeson award to S.D., supported in part by the American Federation for Aging Research, the Hartford Foundation, the Atlantic Philanthropies, and the Starr Foundation). Disclosure: The authors report no disclosures.
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