No evidence for the efficacy of aspirin for people with vascular dementia

Rands G, Orrell M, Spector AE

Published Online:

October 8, 2008

Vascular dementia results from changes in the blood supply to the brain. This may occur from blockages in the arterial and/or capillary systems. Aspirin decreases TXA2 synthesis without significantly reducing prostacyclin synthesis thus causing reduced platelet aggregation and peripheral vasodilation. Aspirin has been shown to be useful in the management of stroke and is widely prescribed for patients with vascular dementia. It may increase the risk of haemorrhage, potentially worsening the outcome in both conditions. There is no good empirical evidence that aspirin affects cognition and improves the prognosis of people with vascular dementia.

Abstract (click to read)

Background:

Aspirin is widely prescribed for patients with a diagnosis of vascular dementia; in one study, completed by geriatricians and psychiatrists in the UK, 80% of patients with clinical diagnoses of vascular dementia were prescribed aspirin. However, a number of queries remain unanswered. Is there convincing evidence that aspirin benefits patients with vascular dementia? Does aspirin affect cognition, behaviour, or improve prognosis? In addition, does the risk of cerebral or gastric haemorrhage outweigh any benefit?

Objectives:

To assess the evidence of effectiveness of the use of aspirin for vascular dementia.

Search strategy:

The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS were searched on 5 January 2008 using the terms: aspirin OR vascu* OR multi-infarct. The CDCIG Specialized Register contains records from all major health care databases (CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS) as well as from many trials databases and grey literature sources.

In addition, relevant web sites were searched and some journals were hand searched. Specialists in the field were approached for unpublished material and any publications found were searched for additional references.

Selection criteria:

All randomized controlled trials investigating the effect of aspirin for vascular dementia are included. Inclusion/exclusion of studies comprised systematic assessment of the quality of study design and the risk of bias.

Data collection and analysis:

Data were extracted independently by both reviewers, using a previously tested data extraction form and, where required, authors were contacted for data not provided in the papers. The aim is to evaluate data recorded via tools assessing cognitive and behavioural changes along with mortality, morbidity and institutionalization data.

Main results:

No trials are eligible for inclusion in this review.

Authors' conclusions:

The most recent search for references to relevant research was carried out in January 2008, but no new trials were found for inclusion.

There is still no good evidence that aspirin is effective in treating patients with a diagnosis of vascular dementia.

Further research is needed to assess the effect of aspirin on cognition, and on other outcomes such as morbidity, mortality, institutionalization, behaviour and quality of life. At present there is no evidence relating to other queries about the use of aspirin for dementia (these are described in the Background section of this review).

This record should be cited as:

Rands G, Orrell M, Spector AE. Aspirin for vascular dementia. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD001296. DOI: 10.1002/14651858.CD001296

Assessed as up to date:

May 20, 2008

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Primary Review Group:

Dementia and Cognitive Improvement Group

Health topics:

Mental health > Dementia & cognition > Interventions aimed at causes of the disease

Neurology > Dementia & cognition > Treatment aimed at causes of the disease

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

No evidence for the efficacy of aspirin for people with vascular dementia

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