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April 2009

Can Treatment With Nonsteroidal Anti-inflammatory Drugs Protect From Dementia?

Arch Neurol. 2009;66(4):538-542. doi:10.1001/archneurol.2009.52

The Alzheimer's Disease Anti-inflammatory Prevention Trial (ADAPT) results published recently in the Archives1 attempt to add data on the potential effect of nonsteroidal anti-inflammatory drugs (NSAIDs) in preventing the development of Alzheimer disease (AD). Unfortunately, the untimely termination of the study limits the conclusions that can be drawn.

The hypothesis leading to this expensive study is not formulated in the article, but presumably it was that NSAIDs will reduce the incidence of AD. Therefore, an implicit assumption has been that there will be a number of subjects who will convert to dementia over the observation period. We are not told whether any subjects have actually converted as the data only convey mean results on cognitive tests. Moreover, it seems that no tests showed significant reductions in cognitive scores in the control group. If this is so, one cannot test even a modified hypothesis that NSAIDs protect from cognitive decline as measured by these tests. The fact that subjects in the NSAIDs arms did have declining scores is immaterial to this conclusion.

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