Protective effect of chronic NSAID use on cognitive decline in older persons.
Protective effect of chronic NSAID use on cognitive decline in older persons.
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DOI：
10.1111/j.1532-5415.1996.tb02932.x
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发表时间：
1996-09-01
影响因子：
6.3
通讯作者：
Guralnik, JM
中科院分区：
文献类型：
--
作者：
Rozzini, R;Ferrucci, L;Guralnik, JM
目的：验证是否长期使用非甾体抗炎药（NSAID）对老年人认知功能下降具有保护作用。设计：前瞻性研究，为期3年的观察期。设置：三个社区的老年人流行病学研究（EPESE）。对象：一个基于人口的样本7671名受试者谁收到了在第六次年度随访的个人访谈。在访谈时和3年前有记录的NSAID使用者被认为是慢性使用者（21%），而所有其他人被认为是非使用者。主要观察指标：认知功能随时间的变化，以简短便携式精神状态问卷（SPMSQ）的9项版本的正确答案的数量进行评估。对于观察期开始时测量的每个SPMSQ评分水平，3年后慢性NSAID使用者的平均SPMSQ评分高于非使用者。在观察期结束时，调整初始SPMSQ评分和潜在混杂因素后，慢性NSAID使用者的认知功能显著高于对照组。年龄较大、女性、教育程度和脑血管病史也是SPMSQ评分较低的独立预测因素。在多变量分析中，估计使用NSAID的保护作用的大小与3.5岁的年龄差异相当。慢性NSAID使用者中开始高于特定SPMSQ评分临界点并在3年内恶化至低于该临界点的患者百分比显著低于非使用者（30.2% vs 34.3%，P = 0.03，SPMSQ评分下降至8分以下，12.3% vs 14.4%，P = 0.04）。在控制了潜在的混杂因素后，与非NSAID使用者相比，慢性NSAID使用者认知功能下降的相对风险为0.82（95%置信区间：0.69-0.98）下降低于8分，0.80（95%CI：0.66-0.98）。结论：这些结果支持NSAID的使用与老年人认知能力下降的减少之间的联系。最终，必须进行随机对照试验以明确证明有益效果。
OBJECTIVE: To verify whether chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) has a protective effect against cognitive decline in older persons.DESIGN: Prospective study with a 3-year observation period.SETTING: Three communities of the Established Populations for Epidemiologic Studies of the Elderly (EPESE).SUBJECTS: A population-based sample of 7671 subjects who received an in-person interview at the sixth annual follow-up. Persons with documented NSAID use at the time of the interview and 3 years before were considered chronic users (21%), while all other persons were considered as nonusers.MAIN OUTCOME MEASURE: Change over time in cognitive function assessed as the number of correct answers to a 9-item version of the Short Portable Mental Status Questionnaire (SPMSQ).RESULTS: For every level of SPMSQ score measured at the beginning of the observation period, the mean SPMSQ score after 3 years was higher in chronic NSAID users than in nonusers. Cognitive function at the end of the observation period was significantly higher in chronic NSAID users than in controls, adjusting for initial SPMSQ score and potential confounders. Older age, female gender, education, and history of cerebrovascular disease were also independent predictors of lower SPMSQ score. In the multivariate analysis, the magnitude of the protective effect estimated for NSAID use was comparable to a difference in age of 3.5 years. The percentage of persons who started above a specific SPMSQ score cut-point and deteriorated below that cut-point over a 3-year period was significantly lower in chronic NSAID users than in nonusers (30.2% vs 34.3%, P = .03, for decline below SPMSQ score of 8 and 12.3% vs 14.4% for decline below SPMSQ score of 6, P = .04). After controlling for potential confounders, the relative risk of cognitive declining in chronic NSAID users compared with nonusers was 0.82 (95% Confidence Interval: 0.69-0.98) for a decline below a score of 8, and 0.80 (95% CI: 0.66-0.98) for a decline below a score of 6.CONCLUSIONS: These results support the association between NSAID use and reduction in cognitive decline in older persons. Ultimately, randomized controlled trials must be done to prove a beneficial effect definitively.