title: Patterns of anti-inflammatory drug use and risk of dementia: a matched case-control study.
abstract: OBJECTIVE
  There is limited primary-care-based evidence about a potential association between anti-inflammatory therapy and dementia subtypes. The present study addressed this limitation by using electronic health records from a large primary care database.
  
  
  METHODS
  A case-control study was implemented using electronic medical records. Cases had a diagnosis of dementia between 1992 and 2014. Up to four controls matched on age, gender, family practice and index date were selected for each case. Use of non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoid drugs represented the exposure variables. Primary outcome measures included all-cause dementia and main dementia subtypes, including Alzheimer disease (AD), vascular dementia (VaD) and Lewy body dementia (LBD). Data were analysed using conditional logistic regression.
  
  
  RESULTS
  The study identified 31,083 patients with AD, 23,465 with VaD and 1694 with LBD. Ever-used NSAIDs were associated with a modest increase in the risk of all-cause dementia (odds ratio 1.04, 95% confidence interval 1.02-1.05, P < 0.006), whilst no association was apparent for ever-used glucocorticoids (0.98, 0.96-1.01, P = 0.152). There was no evidence for an association between NSAIDs and AD (1.03, 0.99-1.06, P = 0.07) or LBD (1.13, 0.99-1.29, P = 0.08). However, a significant increase in the risk for VaD (1.33, 1.29-1.38, P < 0.001) was observed. Similar patterns emerged for glucocorticoid therapy.
  
  
  CONCLUSIONS
  In a large primary care population, there was no robust evidence for a potential association between anti-inflammatory drugs and risk of AD or LBD. NSAIDs and glucocorticoid drugs were associated with higher risk of VaD.
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London, UK.|NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Dregan
authors.affiliation: British Heart Foundation Centre, King's College London, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Chowienczyk
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Armstrong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000139:chemically induced* / Q000453:epidemiology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016022:Case-Control Studies; D015140:Dementia, Vascular / Q000139:chemically induced* / Q000453:epidemiology; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D020961:Lewy Body Disease / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids
keywords: Alzheimer disease; Lewy body dementia; case-control; electronic medical records; glucocorticoids; non-steroidal anti-inflammatories; vascular dementia