No significant effect of aspirin on reducing cognitive impairment

Aspirin did not significantly reduce dementia outcomes in patients from the ASCEND trial with diabetes. The results were based on 1,146 dementia events and trended towards a beneficial effect of aspirin, excluding harms >2%. Subgroup analyses could provide insight into the extent to which certain populations may benefit from long-term aspirin use.

Prof. Jane Armitage (Oxford University, UK) explained that the effect of aspirin on cognitive impairment could be beneficial by avoiding ischaemic events in the brain [1]. However, there could be a harmful effect of aspirin on cognitive impairment via the increased risk of intracranial bleeding. Prior randomised trials have not observed a clear effect of aspirin on cognitive impairment.

In the current analysis, patients with diabetes from the ASCEND trial (NCT00135226; n=15,480; mean age 63 years) were randomised to aspirin (100 mg daily) or placebo. They were followed for 7.4 years in the trial plus an additional 1.8 years post-trial. Key outcomes were dementia, a broad and narrow definition, and a cognitive function test: the Telephone Interview for Cognitive Status and verbal fluency (TICSm) or the Healthy Minds test.

The observational analysis of the study showed an increased risk of dementia following serious vascular events (i.e. myocardial infarction, ischaemic stroke, or transient ischaemic attack; rate ratio 2.40) and intracranial bleeding (rate ratio 1.96). The randomised analysis did not show a significant effect of aspirin on dementia (aspirin 7.1% vs placebo 7.8%; rate ratio 0.91) or cognitive function (mean z-score aspirin 0.004 vs placebo -0.002; rate ratio 0.012).

“The results of this study are relevant since individuals with diabetes have a higher risk of dementia,” said discussant Prof. Amytis Towfighi (University of Southern California, CA, USA). “Another large trial investigating the effect of aspirin on cognitive impairment, the ASPREE trial (NCT01038583), did not demonstrate a difference between aspirin and placebo regarding the incidence of dementia. However, the JPAD trial (NCT00110448), with approximately 2,500 enrolled patients with type 2 diabetes showed a protective effect of aspirin on dementia for women (HR 0.56). Therefore, future studies may consider subgroup analyses to evaluate which groups may benefit from long-term aspirin use. We could also assess other antiplatelet therapies, with more favourable bleeding profiles,” concluded Prof. Towfighi.

 

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   1. Parish S, et al. Effects of aspirin on dementia and cognitive impairment in the ASCEND trial. LBS07, AHA Scientific Sessions 2021, 13–15 November.

 

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Posted on 14 January 202227 March 2024