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Does NSAID use modify cognitive trajectories in the elderly? The Cache County study.

K M Hayden1, P P Zandi, A S Khachaturian

  • 1Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA. khayden@duke.edu

Neurology
|July 20, 2007
PubMed
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Starting nonsteroidal anti-inflammatory drugs (NSAIDs) before age 65 may protect against cognitive decline, especially for individuals with APOE epsilon4 alleles. Late-life NSAID initiation showed no cognitive benefit and potential harm in some groups.

Area of Science:

  • Neuroscience
  • Pharmacology
  • Gerontology

Background:

  • Epidemiologic studies suggest nonsteroidal anti-inflammatory drugs (NSAIDs) may prevent Alzheimer disease (AD).
  • Clinical trials have yielded conflicting results regarding NSAID efficacy for AD prevention or treatment.
  • Limited research exists on NSAID effects on long-term cognitive trajectories.

Purpose of the Study:

  • To investigate the association between nonsteroidal anti-inflammatory drug (NSAID) use and cognitive trajectories in older adults.
  • To determine if the timing of NSAID initiation influences cognitive decline.
  • To explore the role of APOE genotype in the relationship between NSAID use and cognition.

Main Methods:

  • A cohort of 3,383 cognitively normal residents aged 65+ in Cache County, UT, was studied.

Related Experiment Videos

  • Participants provided medication inventories and completed the Modified Mini-Mental State Examination (3MS) at baseline, 3, and 8 years.
  • Random effects modeling was used to analyze the association between NSAID use and 3MS scores over time.

    • Main Results:

    • NSAID initiation before age 65 showed cognitive protection, particularly in APOE epsilon4 carriers (0.40 points/year improvement).
    • Starting NSAIDs at or after age 65 had mixed results: APOE epsilon4 carriers had higher baseline scores but no change over time.
    • Individuals without APOE epsilon4 starting NSAIDs after 65 experienced accelerated cognitive decline (-0.16 points/year).

    Conclusions:

    • Midlife initiation of NSAIDs may offer protection against cognitive decline in older adults.
    • The cognitive benefits of NSAIDs appear more pronounced in individuals with one or more APOE epsilon4 alleles.
    • Late-life NSAID initiation may not be beneficial and could potentially accelerate cognitive decline in certain individuals.