Rozzini R, Ferrucci L, Losonczy K, Havlik R J, Guralnik J M
Geriatric Evaluation and Rehabilitation Unit, P. Richiedei Hospital, Gussago (BS), Italy.
J Am Geriatr Soc. 1996 Sep;44(9):1025-9. doi: 10.1111/j.1532-5415.1996.tb02932.x.
To verify whether chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) has a protective effect against cognitive decline in older persons.
Prospective study with a 3-year observation period.
Three communities of the Established Populations for Epidemiologic Studies of the Elderly (EPESE).
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.
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).
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.
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.
验证长期使用非甾体抗炎药（NSAIDs）是否对老年人认知功能衰退具有保护作用。
为期3年观察期的前瞻性研究。
老年流行病学研究既定人群（EPESE）的三个社区。
基于人群的7671名受试者样本，在第六次年度随访时接受了面对面访谈。在访谈时以及访谈前3年有NSAIDs使用记录的人被视为长期使用者（21%），而所有其他人均被视为非使用者。
认知功能随时间的变化，通过简短便携式精神状态问卷（SPMSQ）9项版本的正确答案数量来评估。
在观察期开始时测量的每个SPMSQ分数水平上，长期使用NSAIDs者3年后的平均SPMSQ分数高于非使用者。在对初始SPMSQ分数和潜在混杂因素进行调整后，观察期末长期使用NSAIDs者的认知功能显著高于对照组。年龄较大、女性、教育程度以及脑血管疾病史也是SPMSQ分数较低的独立预测因素。在多变量分析中，估计的NSAIDs使用保护作用大小相当于年龄相差3.5岁。在3年期间，起始SPMSQ分数高于特定切点且恶化至该切点以下的人群比例，长期使用NSAIDs者显著低于非使用者（SPMSQ分数低于8分时为30.2%对34.3%，P = 0.03；SPMSQ分数低于6分时为12.3%对14.4%，P = 0.04）。在控制潜在混杂因素后，长期使用NSAIDs者与非使用者相比，SPMSQ分数低于8分时认知衰退的相对风险为0.82（95%置信区间：0.69 - 0.98），SPMSQ分数低于6分时为0.80（95%置信区间：0.66 - 0.98）。
这些结果支持NSAIDs使用与老年人认知衰退减少之间的关联。最终，必须进行随机对照试验以明确证明其有益效果。
