Large observational studies have linked regular use of painkillers such as ibuprofen (Advil) and naproxen (Aleve) with lowered risk of Alzheimer’s, but clinical trials have not backed this up. The publication of the results of two new studies this month didn’t do much to resolve this issue. In the first study, Boston University researchers analyzed the medical records of hundreds of thousands of military veterans, and found long-term use of NSAIDs (non-steroidal anti-inflammatory drugs), particularly ibuprofen, was associated with a reduced risk of Alzheimer’s.
A detailed analysis of the results of the second study, ADAPT (Alzheimer's Disease Anti-inflammatory Prevention Trial), was published this month. It showed that neither naproxen nor another NSAID, celecoxib, improved thinking and memory in more than 2000 men and women 70 years and older who had a family history of Alzheimer’s. Naproxen actually seemed to worsen cognition. The trial was stopped early because scientists worried about the side effects of the two painkillers.
Differences in study design could explain these conflicting results.
So, what DO we know about NSAIDs and memory loss? “After the onset of dementia, anti-inflammatory treatment does not seem to work,” says Dr. Constantine Lyketsos, one of the researchers involved in ADAPT. “The data are pretty strong.” Dr. Lyketsos is Director of the Memory and Alzheimer’s Treatment Center at Johns Hopkins University and Chairman of the Department of Psychiatry at Johns Hopkins Bayview Medical Center.
If treatment with NSAIDs does not seem to be effective, what about prevention?
"At present, there is only one randomized trial and that is ADAPT, in which treatment had to be stopped early,” says Dr. Lyketsos. “It does not support the idea that within a few years of dementia onset, the NSAIDs used prevent Alzheimer’s disease. As the observational studies suggest, other NSAIDs might, or the same ones might if given for longer and or earlier in life.”
“Still, right now people are not advised to use NSAIDs to treat or prevent Alzheimer’s disease or memory disorders,” he says. “These drugs carry risks, and as we found in ADAPT, some may have the possibility of being harmful to cognition.”
Another NSAID, Flurizan, is in trial for treatment of Alzheimer’s. Research is focused on its ability to lower levels of beta amyloid (the protein thought to cause Alzheimer’s), rather than on any anti-inflammatory properties. Results are due out this summer.