No evidence for the use of aspirin, steroids or NSAIDs for the treatment of Alzheimer’s disease

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Alzheimer’s disease affects 1-2% of people aged 65-70 and approximately 20% of those over 80 years. As our population ages, the condition is on the increase and it’s estimated that 2030, an estimated 7.7 million Americans aged 65 and older will have Alzheimer’s disease.

We do not yet know exactly how and why Alzheimer’s disease develops, but one popular hypothesis is that inflammation in the brain may be associated with the condition.

Community surveys have been published that show that people receiving anti-inflammatory drugs for various medical conditions may be less likely to develop Alzheimer’s disease.

This new systematic review from the Cochrane Dementia and Cognitive Improvement Group set out to review the efficacy and side effects of aspirin, steroidal and non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of Alzheimer’s disease, compared to placebo.

They conducted a thorough search and found 14 randomised controlled trials that met their inclusion criteria. They grouped the trials into the following categories:

  1. Aspirin (three interventions)
  2. Steroids (one intervention)
  3. Traditional NSAIDs (six interventions)
  4. Selective cyclooxygenase-2 (COX-2) inhibitors (five interventions)

The quality of the studies was variable. They assessed the risk of bias as low for five studies, high for seven studies, and unclear for two studies.

Here’s what they found:

  • There was no significant improvement in cognitive decline for aspirin, steroid, traditional NSAIDs and selective COX-2 inhibitors
  • Compared to controls, patients receiving aspirin experienced more bleeding while patients receiving steroid experienced more hyperglycaemia, abnormal lab results and face oedema
  • Patients receiving NSAIDs experienced nausea, vomiting, elevated creatinine, elevated LFT and hypertension
  • A trend towards higher death rates was observed among patients treated with NSAIDS compared with placebo and this was somewhat higher for selective COX-2 inhibitors than for traditional NSAIDs

The reviewers concluded:

Aspirin, steroid and non-steroidal anti-inflammatory drugs (NSAIDs) (traditional and the selective cyclooxygenase-2 (COX-2) inhibitors) showed no significant benefit in the treatment of Alzheimer’s disease. Therefore, the use of these drugs cannot be recommended for the treatment of Alzheimer’s disease.

Jaturapatporn D, Isaac MGEKN, McCleery J, Tabet N. Aspirin, steroidal and non-steroidal anti-inflammatory drugs for the treatment of Alzheimer’s disease. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD006378. DOI: 10.1002/14651858.CD006378.pub2.

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