Does low-dose acetylsalicylic acid prevent cognitive decline in women with high cardiovascular risk? A 5-year follow-up of a non-demented population-based cohort of Swedish elderly women

Overview

In addition to its effects on cardiovascular risk and cancer mortality, in older women low-dose aspirin may also help preserve cognitive function. Cognitive function determines one’s ability to handle complex tasks and use intellectual reasoning, judgment, language, memory, and visual and spatial orientation in everyday life. To evaluate the benefits of aspirin on cognitive function, this article evaluated 681 elderly Swedish women (average age 75) at high risk of cardiovascular disease, over a 5-year period. Women who regularly took aspirin had significantly better cognitive function compared with women who did not take aspirin.

Methodology

This observational study evaluated 681 women in Sweden over a 5-year period in order to evaluate the benefits of aspirin on cognitive function. The study was not randomized, and the women were surveyed to determine their regular medications, including daily aspirin. The women were assessed for cognitive impairment and dementia using a standard mini-mental status examination (MMSE) and other neurological and psychiatric tests at regular intervals. These standardized tests, examining different intellectual tasks, were designed to assess for the development of dementia and the extent of cognitive impairment. Almost all of the women in the study had a high risk of cardiovascular disease, based on their risk factors and age. Individuals with dementia and users of warfarin, clopidogrel or heparin at baseline were excluded from the study.

While more detailed information on aspirin use among the women in the study would have been ideal, the researchers only had information on low-dose aspirin use at the start of the study and again five years later. From this information, the 489 women who were available at the end of a 5-year monitoring period were separated into four groups, those who: 1) never took daily aspirin (338 participants), 2) took daily aspirin at the start and conclusion of the monitoring period (66 participants), 3) at the start but not the conclusion (18 participants), and 4) took it at the conclusion but not the start (67 participants). Low-dose aspirin was defined as daily doses between 75 mg and 160 mg.

Results

  • Women who took low-dose aspirin had significantly better cognitive function compared with women who did not take aspirin.

  • The difference was most pronounced with the patients who reported taking aspirin at the start and end of the 5-year study. This is the group most likely to have had the greatest exposure to aspirin over the five years.

Conclusions

  • Older women at higher risk of cardiovascular disease may preserve cognitive function by taking low-dose daily aspirin. Women who took regular aspirin had a significantly better cognitive function compared with women who did not take aspirin.

  • The benefits were greater for women taking aspirin the longest. The difference was most pronounced with the patients who reported taking aspirin at the start and at the conclusion of the study.

  • More definitive information is needed. Because women were not randomized into these groups, other factors could be involved in explaining these results. The authors suggest that prevention of cognitive decline may be another preventive benefit of aspirin, but that more definitive information is needed.