Aspirin and cognitive functionBMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39204.473252.80 (Published 10 May 2007) Cite this as: BMJ 2007;334:961
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Clinicians, tempted to alter clinical practice after reading Whalley
and Mowat’s (1) declaration that “treatment of hypertension is beneficial
in older people with well established cognitive benefits, possibly
including transition to dementia” should exercise caution. The Cochrane
Review of McGuinness et al (2) serves as a brake to those who might be
tempted by attractive epidemiological data and indeed a reasonable
pathophysiological argument implicating hypertension in the development of
dementia. While the Syst-Eur (3) study that the authors cite did show a
benefit with treatment in the prevention of dementia, the only other
trials to deal with dementia prevention in those without established
cerebrovascular disease namely SCOPE (4) and SHEP (5) failed to show any
advantage. When the three trials were entered in a meta-analysis no
significant effect was seen on either dementia rates or MMSE. Firm
conclusions in this area are further limited by heterogeneity between
clinical trials, the presence of adverse events leading to patient drop
outs, and instances whereby control subjects received antihypertensive
drugs thus lowering their blood pressure. Well established cognitive
benefits? Rather a dire need to establish meaningful RCTs.
1. Kang JH, Cook N, Manson J, Buring JE, and Grodstein F. Low dose
aspirin and cognitive function in the women's health study cognitive
cohort, BMJ 2007;334:961-962.
2. McGuinness B, Todd S, Passmore P, Bullock R. The effects of blood
pressure lowering on development of cognitive impairment and dementia in
patients without apparent prior cerebrovascular disease. Cochrane Database
Syst Rev 2006 Apr 19;(2):CD004034.
3. Forette F, Seux ML, Staessen JA, Thijs L, Birkenhager WH, Babarskiene
MR, et al. Prevention of dementia in randomised double-blind placebo-
controlled Systolic Hypertension in Europe (Syst-Eur) Trial. Lancet
4. Lithell H, Hansson L, Skoog I, Elmfeldt D, Hofman A, Olofsson B et al.,
for the SCOPE Study Group. The Study on Cognition and Prognosis in the
Elderly (SCOPE): principal results of a randomised double-blind
intervention trial. J Hypertens 2003;21:875-886.
5. Di Bari M, Pahor M, Franse LV, Shorr RI, Wan JY, Ferrucci L, et al.
Dementia and Disability Outcomes in Large Hypertension Trials: Lessons
Learned from the Systolic Hypertension in the Elderly Program (SHEP)
Trial. Am J Epidemiol 2001;153:72-8.
Competing interests: No competing interests