Thursday, November 22, 2001

Dutch researchers have found the strongest evidence yet that pain relievers such as Advil, Aleve and Motrin may ward off Alzheimer’s disease.
A large study of people 55 or older concluded those who took certain nonsteroidal anti-inflammatory medicines every day for at least two years were 80 percent less likely to develop Alzheimer’s.
Scientists first noticed in the mid-1990s that regular use of these drugs for aches and pains may protect against Alzheimer’s. Studies in the late 1990s found no such effect, but had flaws such as asking people with Alzheimer’s to recall their past medication use.
The Dutch study appears to solve that problem because it drew information on the patients’ drug use from a national database in Holland.
Still, the lead author, Bruno Stricker, said researchers must confirm the results with controlled experiments in which patients are randomly assigned to take either anti-inflammatory drugs or dummy pills.
Mr. Stricker and other specialists warned people not to start taking NSAIDs on their own. Anti-inflammatory drugs such as ibuprofen and naproxen can cause serious, sometimes fatal side effects such as gastrointestinal bleeding and kidney damage.
“Whatever you do, go to your doctor first,” said Mr. Stricker, a professor of clinical epidemiology at Erasmus University Medical Center in Rotterdam.
The research was reported in today’s New England Journal of Medicine.
Doctors studied 6,989 persons, many of whom had been prescribed anti-inflammatory medications for joint problems.
The patients were evaluated in the early 1990s to be sure they did not have Alzheimer’s.
They were followed on average for seven years to see which ones developed the incurable mind-robbing disease. Checking Holland’s national pharmacy database, the researchers determined which patients took NSAIDs and for how long.
Altogether, 293 patients were diagnosed with Alzheimer’s and 101 others developed other types of dementia.
For people who already have Alzheimer’s, Mr. Stricker said, “There’s no reason to believe that treatment with these drugs would improve symptoms.”
The Dutch researchers believe NSAIDS work against Alzheimer’s by relieving minor brain inflammation. However, other researchers reported last week that NSAIDS appear to work by inhibiting production of a protein found in the buildups that clog brain cells.
In the Dutch study, one of the most commonly used NSAIDs, aspirin, did not reduce Alzheimer’s risk at all. Likewise, none of the 17 anti-inflammatory drugs used by patients in the study cut the risk of vascular dementia, in which repeated, undetected minor strokes damage the brain.
Alzheimer’s causes about two-thirds of all dementia cases; other causes include heavy drinking. Roughly 4 million Americans have the disease.
Because the Dutch government provides medicines free with a prescription, the extensive pharmacy records provided much better data than were available in previous studies, said Neil Buckholtz, chief of the Dimensions of Aging Branch at the U.S. National Institute on Aging.
The institute is enrolling 2,500 patients in a new study comparing the potential protective effects of two widely used drugs naproxen, also known as Aleve, and the newer Celebrex with dummy pills. Results are expected around 2008.
Dr. John C.S. Breitner and Peter P. Zandi of Johns Hopkins University in Baltimore wrote in an accompanying editorial that the Dutch study appears to resolve puzzling conflicts among previous studies on the topic.

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