Aspirin for vascular dementia.
BACKGROUND
For patients with a diagnosis of vascular dementia there is evidence that aspirin is widely prescribed - in one study, completed by geriatricians and psychiatrists in the UK, 80% of patients with cognitive impairment (with vascular risk factors) 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 or improve prognosis? In addition, does the risk of cerebral or gastric haemorrhage outweigh any benefit? The aim of this review is to assess the evidence of effectiveness of aspirin in those with a diagnosis of vascular dementia.


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


METHODS
Computerised databases were searched independently by two reviewers. In addition, relevant websites were searched and some journals were handsearched. Specialists in the field were approached for unpublished material and also any publications found were searched for additional references.


METHODS
All randomised 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.


METHODS
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 was to evaluate data recorded via tools assessing cognitive and behavioural changes along with mortality, morbidity and institutionalisation data.


RESULTS
One randomised controlled trial ( approximately approximately Meyer 1989 approximately approximately ) was included, and yielded data for analysis on a total of 70 patients. The only relevant outcome assessed in this trial was cognition. Change in cognitive outcome was towards being in favour of treatment.


CONCLUSIONS
There is very limited 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 also on additional outcomes such as behaviour, and quality of life. At present it is not possible to provide evidence for other queries regarding the use of aspirin for dementia (these are described in the Background section of this review).
Williams
P S
PS
Child & Adolescent Psychiatry, Camden & Islington CHS NHS Trust, 186a Park Road, Crouch End, London, UK, N8 8JJ. plastix@cableinet.co.uk
Spector
A
A
Orrell
M
M
Rands
G
G
D001241:Aspirin / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000188:drug therapy; D015140:Dementia, Vascular / Q000188:drug therapy*; D006801:Humans
D001241:Aspirin