Bl. Flynn et Ka. Theesen, Pharmacologic management of Alzheimer disease part III: Nonsteroidal antiinflammatory drugs - Emerging protective evidence?, ANN PHARMAC, 33(7-8), 1999, pp. 840-849
OBJECTIVE: TO provide information about research evaluating the role of non
steroidal antiinflammatory drugs (NSAIDs) in the prevention, or delay in th
e onset of, Alzheimer disease (AD).
DATA SOURCES: Studies, review articles, and editorials identified from MEDL
INE searches (January 1990-December 1996) and bibliographies of identified
articles. The addendum lists articles from 1996 to June 1999,
STUDY SELECTION: Studies, review articles, and editorials addressing NSAIDs
and AD pharmacotherapy research,
DATA EXTRACTION: Pertinent information was selected and the data synthesize
d into a review format.
DATA SYNTHESIS: AD is a complex disorder and there are numerous factors inv
olved in the process. The pathology of AD is characterized by the developme
nt of amyloid plaques and neurofibrillary tangles. In addition, more than 4
0 immunoprotective proteins that are not unique to AD are found at autopsy
that are normally absent, or present in very low concentrations, in normal
brain. These findings suggest that AD may involve an inflammatory process.
Preliminary results from studies investigating the incidence and onset of A
D in patients with arthritis who have taken NSAIDs suggest that NSAIDs may
have a protective effect. Studies evaluating the possible association betwe
en arthritis, NSAIDs, and AD are reviewed,
CONCLUSIONS: Preliminary evidence suggests that NSAIDs may have a protectiv
e effect against the development of AD, Further prospective, double-blind,
placebo-controlled studies are needed to determine the role of NSAIDs in AD
. These dose-finding studies should focus on specific agents and identify t
he dosage and duration of therapy necessary for a protective or therapeutic
effect. Additionally, not all elderly patients are candidates for NSAIDs.
Determining the definitive mechanism of action of NSAIDs in AD may suggest
alternative agents that have similar pharmacologic activity, but are associ
ated with fewer adverse effects.