Published 18 August 2009, doi:10.1136/bmj.b3352
Cite this as: BMJ 2009;339:b3352

Letters

White matter and ageing

Osteoarthritis and protection from global functional decline

The first 150 words of the full text of this article appear below.

Inzitari and colleagues describe the association between white matter changes in older patients and subsequent functional decline.¹ Their findings show that new occult markers of disease may exist and reinforce some of the intuition of clinicians dealing with elderly patients, raising some interesting issues.

Firstly, although education conferred a protective effect on subsequent decline, the presence of osteoarthritis conferred stronger protection than a year of education, even when adjusted for other risk factors. The anti-inflammatory effect from the concomitant use of non-steroidal anti-inflammatory drugs (NSAIDs) may have conferred some benefit. NSAIDs selective for cyclo-oxygenase-2 (COX 2 inhibitors) increase cardiovascular risk,² but the evidence of harm from non-selective NSAIDs is limited.³ Indeed, some beneficial effects of non-selective NSAIDs on cognitive decline, albeit contended, have been noted.⁴ Were data on drug treatment collected? If so, was NSAID use or class of NSAID associated with progression to death or disability? Issues of statistical . . . [Full text of this article]

¹ Royal Hospital, Donnybrook, Dublin 4, Republic of Ireland, ² St Vincent’s University Hospital, Dublin 4

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Relevant Article

Changes in white matter as determinant of global functional decline in older independent outpatients: three year follow-up of LADIS (leukoaraiosis and disability) study cohort

Domenico Inzitari, Giovanni Pracucci, Anna Poggesi, Giovanna Carlucci, Frederik Barkhof, Hugues Chabriat, Timo Erkinjuntti, Franz Fazekas, José M Ferro, Michael Hennerici, Peter Langhorne, John O’Brien, Philip Scheltens, Marieke C Visser, Lars-Olof Wahlund, Gunhild Waldemar, Anders Wallin, Leonardo Pantoni on behalf of the LADIS Study Group
BMJ 2009 339: b2477. [Abstract] [Full Text] [PDF]

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