Implications for practice and research

• Further studies of nonsteroidal anti-inflammatory drugs need to give due attention to the safety concerns arising from these existing studies.

• Monitoring the risks of bleeding when prescribing aspirin or non-steroidal medications for patients with dementia in clinical practice is important.

Context

According to the Centers for Disease Control and Prevention, 5 million adults were diagnosed with dementia in 2014; projected to rise to approximately 14 million by 2060.1 This is a significant health problem, as dementia prevalence is increasing. Therefore, practitioners need to understand how it can be prevented and treated effectively. To date, no available medication exists to prevent or delay the onset of dementia. It has been reported that the pathogenesis of dementia was associated with inflammation; therefore, medications with anti‐inflammatory properties such as aspirin and Nonsteroidal anti-inflammatory drugs (NSAIDs) could be beneficial for dementia prevention.2

Findings

The review included a total of four randomised controlled trials with 23 187 participants. It was reported that the use of low‐dose aspirin (100 mg daily) or other NSAIDs did not prevent dementia in healthy older people but that there were reports of significant adverse effects.2 The findings revealed that aspirin and other NSAIDs can cause major bleeding as compared with the placebo group, and a higher rate of death was also reported in one of the trials.2 Furthermore, other adverse effects noted in the NSAIDs group included gastritis, nausea, stomach pain and bleeding symptoms. Consequently, there is a lack of evidence to support the use of aspirin and other NSAIDs (eg, celecoxib, rofecoxib or naproxen) studies in the prevention of dementia.2

Commentary

The review investigated the effectiveness and safety measures associated with aspirin and other NSAIDs for the primary or secondary prevention of dementia. Dementia is a neuroinflammatory disease, where the preservation of cognitive function is a major concern.2 Many question the usefulness of aspirin and other NSAIDs in preventing or delaying the onset of dementia; however, this Cochrane review found no evidence to support this.2 Although there were limitations in the available evidence, it seems unlikely that there is any need for further trials of low-dose aspirin for dementia prevention. If future studies of NSAIDs for dementia prevention are planned, they will need to be cognisant of the safety concerns arising from the existing studies.

Dementia can cause cognitive impairment, which can inhibit a patient’s independence. Practitioners need to understand dementia risks factors, health prevention and treatments to avoid further health complications; it is a high public importance. Dementia can be prevented; therefore, practitioners need to understand the risk factors associated with the condition including neuropathological damage and maintained cognitive reserve.3 For example, neuropathological damage associated with health prevention for dementia include reducing obesity, stopping smoking, treating hypertension and diabetes and preventing air pollution.3 Other strategies include increasing cognitive reserve to maintain frequent social contact, avoiding excessive alcohol intake, reducing occurrence of depression, maintaining frequent exercise and a healthy diet.3

Practitioners need to develop new interventions and strategies when prescribing medications to prevent bleeding. The review found aspirin and other NSAIDs showed no benefit for reducing dementia; instead higher rates of death were observed. Future studies should be mindful of the safety concerns of these medications. Evidence revealed that well-being is the goal of dementia care; therefore, it is essential to teach patients and families about safety measures to prevent injuries for safe and quality of life.4