Abstract
Background: More people with cognitive dysfunction and dementia also fall into the category of high vascular risk, for which aspirin is one of the most frequently used drugs. However, previous studies reporting that aspirin buffers against mild cognitive decline (MCI) and dementia remain controversial. We thus conducted an updated systematic review and meta-analysis to evaluate the association of aspirin use with the risk of MCI and dementia in older adults.Methods: Data sources from PubMed, Embase, Web of Science, and the Cochrane Database for randomized controlled trails (RCTs) and cohort studies (published between January 1, 2000 and April 11, 2020). Relative risks (RRs) and 95% confidence intervals (95% CIs) were used to pool data on the occurrence of dementia and MCI with random-effects models.Results: Of 3,193 identified articles, 15 studies (12 cohort studies and three RCTs) were eligible and were included in our analysis, which involved a total of 100,909 participants without cognitive dysfunctions or dementia at baseline. In pooled cohort studies, aspirin use did not reduce the incidence of MCI and dementia (the pooled RR = 0.97; 95% CI = 0.85–1.11; = 65%) compared with non-users. However, low-dose aspirin (75–100 mg/day) was associated with a decreased likelihood of developing dementia or MCI (the pooled RR = 0.75; 95% CI = 0.63–0.9; = 50.5%). This association existed in studies including all-cause dementia (the pooled RR = 0.82; 95% CI = 0.71–0.96) and Alzheimer's disease (AD) (the pooled RR = 0.54; 95% CI = 0.33–0.89), but not in MCI (the pooled RR = 0.58; 95% CI = 0.31–1.08). In RCTs, low-dose aspirin use was not significantly associated with less prevalence of dementia or MCI (RR = 0.94; 95% CI = 0.84–1.05; = 0.0%).Conclusions: In cohort studies, we found that low-dose aspirin use had a higher likelihood of reducing the incidence of dementia, which was not supported by RCTs. The evidence was insufficient to fully evaluate the effect of aspirin on cognitive function and dementia. Well-designed studies and innovative approaches are therefore needed to clarify whether the use of aspirin improves cognitive function and reduces the risk of dementia.
Highlights
The global prevalence of dementia was 50 million people worldwide in 2015, and the number of individuals with dementia could increase to 82 million in 2030 and 152 million by 2050, which will affect ∼5–8% of people ≥60 years old (WHO, 2019)
Twenty-nine articles were examined for full-text review, and 15 studies were included in this meta-analysis (Figure 1)
When restricted to adjusting the dosage for low-dose aspirin, it was associated with a 25% reduction in the risk of incident dementia and mild cognitive decline (MCI) in five cohort studies
Summary
The global prevalence of dementia was 50 million people worldwide in 2015, and the number of individuals with dementia could increase to 82 million in 2030 and 152 million by 2050, which will affect ∼5–8% of people ≥60 years old (WHO, 2019). Previous population-based studies identified risk factors for vascular disease as targets for preventing dementia and cognitive dysfunction (Whalley and Mowat, 2007; Sanford, 2017). Two main mechanisms have concerned the potential protective effect of aspirin use on cognitive decline and dementia in older adults. The other mechanism indicates that aspirin may maintain cerebral blood flow and prevent stroke in patients with ischemic cerebrovascular disease and protect cognitive function via inhibiting cerebral damage of vascular origin (Patrono, 2015). A recent report has investigated the effects of low-dose aspirin to enhance astrocytic lysosome biogenesis and function, which is a newly studied pathway to reduce amyloid pathology in AD (Melo, 2019). Previous studies reporting that aspirin buffers against mild cognitive decline (MCI) and dementia remain controversial. We conducted an updated systematic review and meta-analysis to evaluate the association of aspirin use with the risk of MCI and dementia in older adults
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