On 25 March, Dr Joanne Ryan and the ASPREE Investigator Group published a paper in Neurology, showing that low doses of aspirin do not reduce the risk of mild cognitive impairment (MCI), cognitive decline or dementia. Low-dose aspirin is a widely-prescribed treatment for cardiovascular disease, aimed at reducing the risk of heart attacks and strokes. Classed as a non-steroidal anti-inflammatory drug (NSAID), aspirin reduces inflammation by inactivating pro-inflammatory enzymes called cyclooxygenases (COX). Aspirin also suppresses the normal function of platelets, which accounts for its anti-coagulant, blood-thinning activity. Observational studies have found some evidence to suggest that NSAIDs such as aspirin may be neuroprotective, reducing cognitive decline and diminishing the risk of vascular comorbidities that contribute to the development of dementia.
To solidify this evidence base, the Aspirin in Reducing Events in the Elderly (ASPREE) randomised, placebo-controlled, community-based trial aimed to study the efficacy of low-dose aspirin for the prevention of MCI, cognitive decline or dementia in healthy older individuals. A total of 19,114 community-dwelling, healthy individuals aged ≥70 years were enrolled in the ASPREE trial, randomised 1:1 to daily doses of 1-100mg aspirin or placebo. Cognitive and functional tests were performed at baseline and at regular follow-up intervals, with an average follow-up duration of 4.7 years.
During the follow-up period, 488 participants in the aspirin group were diagnosed with dementia, compared to 476 in the placebo group. Similar numbers of individuals in each group were diagnosed with MCI (205 in aspirin group, 184 in placebo group) and cognitive decline (838 in aspirin group, 816 in placebo group). Subgroup analysis did not reveal any differences in treatment effect according to gender, ethnicity, comorbidities or age. Together, these data show that treatment with low-dose aspirin, for a median period of 4.7 years, is not effective in reducing the risk of cognitive decline, MCI or dementia in healthy older adults.
Link to article: https://n.neurology.org/content/neurology/early/2020/03/25/WNL.0000000000009277.full.pdf
