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Association Between Non-Steroidal Anti-Inflammatory Drug Use and Cognitive Decline: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Abstract

Background

Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used medications in the elderly. They have been widely studied as possible preventive agents against cognitive decline because of the properties of anti-inflammatories, which sustain cerebral blood flow and mitigate the neurotoxicity of microglial cells. However, the results remain controversial.

Objective

Our objective was to assess the effects of NSAID use on the risk of cognitive decline. We reviewed and quantitatively synthesized the evidence from prospective cohort studies via a meta-analysis.

Methods

We identified pertinent studies by searching the PubMed, EMBASE, and China National Knowledge Infrastructure databases through to December 2015 and by reviewing the reference lists of retrieved articles. We used fixed- or random-effects models to pool relative risks (RRs) with 95 % confidence intervals (CIs) and performed sensitivity analyses to evaluate the robustness of the results. Small-study effect was evaluated using Egger’s test and funnel plots.

Results

Of the 2171 articles identified through searching the databases, ten articles including 11 prospective cohort studies were eligible. Overall, NSAID use was associated with a 13 % decreased risk of cognitive decline (pooled RR 0.87; 95 % CI 0.81–0.94). In subgroup analysis, the pooled RRs were 0.89 (95 % CI 0.81–0.98) for follow-up time ≥5 years, 0.85 (95 % CI 0.75–0.96) for follow-up time <5 years, and 0.85 (95 % CI 0.78–0.93) for studies conducted in North America, respectively. Sensitivity analyses found results to be robust. No evidence of significant small-study effect was identified.

Conclusions

This meta-analysis of prospective cohort studies indicates that NSAID use may be associated with a decreased risk of cognitive decline. Larger, high-quality randomized controlled trials are needed to verify the effects of NSAID use on the risk of cognitive decline.

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Correspondence to DongFeng Zhang.

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Source of funding

This work was supported by the National Natural Science Foundation of China (No. 31371024).

Conflict of interest

WeiJing Wang, YanPing Sun, and DongFeng Zhang declare that they have no conflicts of interest relevant to the content of this article.

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Wang, W., Sun, Y. & Zhang, D. Association Between Non-Steroidal Anti-Inflammatory Drug Use and Cognitive Decline: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Drugs Aging 33, 501–509 (2016). https://doi.org/10.1007/s40266-016-0379-9

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Keywords

  • Cerebral Blood Flow
  • Cognitive Decline
  • Prospective Cohort Study
  • Rofecoxib
  • China National Knowledge Infrastructure