Aspirin in people with dementia, long-term benefits, and harms: a systematic review

Abstract

Purpose People with dementia may have indications for aspirin prescription and clinicians are asked to balance the potential risks against benefits. This review examines the evidence for the risk and benefit of long-term aspirin use in people with dementia aged over 65 years, including randomised controlled trials and observational studies. Methods We searched three databases for research published between 2007 and 2020. Each eligible article was assessed for risk of bias, and confidence in findings was rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results Four papers met inclusion criteria: one randomised controlled trial, two cohort studies, and one with pooled data. All looked only at dementia of Alzheimer’s type, and none addressed myocardial or cerebral infarction as outcomes. Dementia progression was reported by two studies, with conflicting results. The trial found no significant effect of aspirin on mortality (odds ratio aspirin vs. no aspirin 1.07, 95% confidence interval 0.58–1.97) but found more events of severe bleeding with aspirin (OR aspirin vs. no aspirin 6.9, 1.5–31.2). An excess in intracranial haemorrhage in the aspirin group was judged plausible based on two non-randomised studies. Conclusions The review findings are limited because studies include only people with Alzheimer’s-type dementia and lack confirmatory studies, although an increased risk of bleeding events is recognised. Further research that addresses the benefits and risks of aspirin in more representative groups of people with dementia is needed to guide prescribing decisions.

Aspirin using was associated with slower cognitive decline in patients with Alzheimer’s disease

“…In line with this finding, among subjects without dementia, Waldstein and colleagues found that NSAIDs use was associated with slower decline on several cognitive domains [ 11 ]. However, another study using the Epidemiology of Hearing Loss Study of participants suggested that the use of aspirin was not associated with progression to cognitive deficits (MCI or dementia diagnosis) [ 20 ], which was consistent with other previous studies [ 14 , 21 – 26 ]. One potential explanation of these inconsistencies is that this association may be modified by the clinical stages.…”

Ten-year trends in adverse drug reaction–related hospitalizations among people with dementia

“… 35 The risk of major cardiovascular events like cerebrovascular accidents and myocardial infarctions is related to many factors that are also risk factors for dementia, including age and cardiovascular disease. 36 Antithrombotics such as aspirin are prescribed to people with dementia for reducing the risks of major cardiovascular events. 36 Our study reported that more than half of ADR-related hospitalizations were due to renally related ADRs.…”

“… 36 Antithrombotics such as aspirin are prescribed to people with dementia for reducing the risks of major cardiovascular events. 36 Our study reported that more than half of ADR-related hospitalizations were due to renally related ADRs. Contrary to this, most studies have reported bleeding as the most common ADR-related diagnosis of hospitalizations.…”

Tratamento da demência: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia

“…Nos casos de CCV sem evidência de AVC prévio, a terapia deve ser individualizada 53 , principalmente em indivíduos com risco significativo de quedas. Nos últimos anos, não foram publicados estudos que comprovem os benefícios dos antiagregantes na evolução do CCV 54 ; • Estatinas: As estatinas são de interesse na prevenção secundária da doença cerebrovascular devido aos seus efeitos hipolipemiantes e pleiotrópicos na função vascular, que se combinam para inibir a aterosclerose. Há boas evidências de que as estatinas administradas tardiamente a pessoas em risco de doença vascular não previnem o declínio cognitivo ou a demência 55 .…”

“…In cases of VCI without evidence of previous stroke, therapy should be individualized 53 , especially in individuals with significant risk of falls. In recent years, no studies have been published providing support for the benefits of antiaggregants in the evolution of VCI 54 ; Statins: Statins are of interest in the secondary prevention of cerebrovascular disease due to both their lipid-lowering and pleiotropic effects on vascular function, combining to inhibit atherosclerosis. There is good evidence that statins given late in life to people at risk for vascular disease do not prevent cognitive decline or dementia 55 .…”