105 Antiplatelet therapy and incident cognitive impairment or dementia—a systematic review and Meta-analysis of randomised clinical trials.

Abstract

Abstract Background The benefit of antiplatelet therapy in the prevention of cognitive impairment or dementia is uncertain. We investigated the association between antiplatelet therapy with incident cognitive impairment or dementia in randomised clinical trials. Methods We searched PubMed, EMBASE, and CENTRAL for randomised clinical trials published from database inception through Feb 1st, 2023. Trials that evaluated the association of antiplatelet therapy with incident cognitive impairment or dementia were included. For single agent antiplatelet, the control group was placebo and for dual agent antiplatelet therapy, the control group was single agent monotherapy. Two authors screened and independently extracted all data, and a random-effects meta-analysis model was used to report pooled treatment effects and 95% Confidence Intervals. The primary outcome was incident cognitive impairment or dementia. Secondary outcomes included change in cognitive test scores. Results Eleven randomised clinical trials were eligible for inclusion (109,860 participants), all of which reported the incidence of cognitive impairment or dementia on follow-up. The mean (SD) age of trial participants was 66.2 (7.9) years and 46,150 (42%) were women. The mean duration of follow-up was 70 months. Antiplatelet therapy, compared to control, was not significantly associated with a reduced risk of cognitive impairment or dementia (11 trials; 109,860 participants) (3.49% vs 4.18% of patients over a mean trial follow-up of 5.8 years; odds ratio [OR], 0.94 [95% CI, 0.88–1.00]; absolute risk reduction, 0.2% [95% CI, −0.4% to 0.009%]; I2 = 0.0%). Antiplatelet therapy was not significantly associated with mean change in cognitive test scores. Conclusion In this meta-analysis of randomised clinical trials, antiplatelet therapy was not significantly associated with a lower risk of incident cognitive impairment or dementia. The confidence intervals around this outcome do not exclude a modest preventative effect, and at a population level this could have a substantial benefit. Further large trials with longer term follow up are needed.