The Pharmaceutical Journal Vol 267 No 7176 p767-773
1 December 2001

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Pharmacy records confirm protective benefit of NSAIDs against Alzheimer's

Computerised pharmacy records in the Netherlands have been used to show that the long-term use of non-steroidal anti-inflammatory drugs protects against Alzheimer's disease. Previous retrospective studies have suggested a link but results have been inconsistent.

Dr Bas in't Veld, Erasmus Medical Centre, Rotterdam, and colleagues were able to estimate the risk of Alzheimer's disease in relation to use of NSAIDs (other than aspirin) using pharmacy records. They screened 7,528 subjects aged 55 years or older and followed-up 6,989 of them who were free of dementia at the start of the study. Over the eight-year study period dementia developed in 394 subjects, of whom 293 had Alzheimer's disease.

Nearly all participants were registered at one or more of the pharmacies serving the local area. The pharmacies were fully automated and recorded complete information on prescriptions (for most of the study period, NSAIDs could only be obtained in the Netherlands by prescription). Diclofenac, ibuprofen and naproxen accounted for approximately 83 per cent of the prescriptions for NSAIDs. The researchers found a reduced risk of Alzheimer's disease in subjects who had taken NSAIDs for a cumulative period of two years or more. The relative risk of developing Alzheimer's disease was 0.95 (95 per cent confidence interval, 0.70 to 1.29) in subjects who used NSAIDs for a cumulative period of less than one month, 0.83 (CI 0.62 to 1.11) in those who used NSAIDs for more than one month but less than 24 months, and 0.20 (0.05 to 0.83) in those who used NSAIDs for 24 months or more. Use of NSAIDs was not associated with a reduction in risk of vascular dementia.

The researchers comment that previous studies used extrapolated data acquired during interviews to assess exposure to NSAIDs. "[Such data] are probably more vulnerable to misclassification than data from pharmacy records," they say (New England Journal of Medicine 2001;345:1515).

In an accompanying editorial, Dr John Breitner and Dr Peter Zandi, Johns Hopkins University, Baltimore, Maryland, say: "Although the timing and duration of the use of NSAIDs appear to be critical to their apparent neuroprotective effect, the findings suggest that the daily dose is not important," (ibid, p1567).

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