Quelle: New England Journal of Medicine

Können freiverkäufliche Schmerzmittel vom Typ der nichtsteroidalen Schmerzmittel (NSAIDS) den Ausbruch der Alzheimerschen Krankheit verhindern?

Eine im New England Journal of Medicine publizierte wissenschaftliche Untersuchung kommt zu dem Schluss, dass die Langzeiteinnahme eines sog. nichtsteroidalen Schmerzmittels (NSAID) das Auftreten der Alzheimerschen Erkrankung (Alzheimer Demenz) stark reduzieren kann. Die Forscher beobachteten einen Rückgang um 80%. 

Gleichzeitig warnen sie vor der Selbstmedikation mit den freiverkauflichen Medikamenten, da diese zu lebensbedrohlichen Nebenwirkungen führen können. Sie sollten daher nie über längere Zeit ohne ärztliche Kontrolle eingenommen werden. 

                            Study: Drugs Cut Alzheimer's Risk

Dutch researchers have found the strongest evidence yet that pain relievers like Advil, Aleve and Motrin may ward off Alzheimer's disease. A large study of people 55 or older concluded that those who took certain nonsteroidal anti-inflammatory medicines every day for at least two  years were 80 percent less likely to develop Alzheimer's.  

Scientists first noticed in the mid-1990s that regular use of these drugs for aches and pains may protect against Alzheimer's. Studies in the late 1990s found no such effect, but had flaws such as asking people with Alzheimer's to recall their past medication use.  The Dutch study appears to solve that problem because it drew information on the patients' drug use from a national database in Holland.  

Still, the lead author, Bruno Stricker, said researchers must confirm the results with controlled experiments in which patients are randomly assigned to take either anti-inflammatory drugs or dummy pills.  

Stricker and other experts warned people not to start taking NSAIDs on their own. Anti-inflammatory drugs such as ibuprofen and naproxen can cause serious, sometimes fatal side effects such as gastrointestinal bleeding and kidney damage. 

"Whatever you do, go to your doctor first," said Stricker, a professor of clinical epidemiology at Erasmus University Medical Center in Rotterdam.  

The research was reported in Thursday's New England Journal of Medicine. Doctors studied 6,989 people, many of whom had been prescribed anti-inflammatory medications for joint problems. The patients were evaluated in the early 1990s to be sure they did not have Alzheimer's. 

 They were followed on average for seven years to see which ones developed the incurable mind-robbing disease. Checking Holland's national pharmacy database, the researchers determined which patients took NSAIDs and for how long.  

Altogether, 293 patients were diagnosed with Alzheimer's and 101 others developed other types of dementia. For people who already have Alzheimer's, Stricker said, "There's no reason to believe that treatment with these drugs would improve symptoms."  The Dutch researchers believe NSAIDS work against Alzheimer's by relieving minor brain inflammation.

However, other researchers reported last week that NSAIDS appear to work by inhibiting production of a protein found in the buildups that clog brain cells.   

In the Dutch study, one of the most commonly used NSAIDs, aspirin, did not reduce Alzheimer's risk at all. Likewise, none of the 17 anti-inflammatory drugs used by patients in the study cut the risk of vascular dementia, in which repeated, undetected minor strokes damage the brain.  

Alzheimer's causes about two-thirds of all dementia cases; other causes include heavy drinking. Roughly 4 million Americans have the disease.  Because the Dutch government provides medicines free with a prescription, the extensive pharmacy records provided much better data than was available in prior studies, said Neil Buckholtz, chief of the Dimensions of Aging Branch at the U.S. National Institute on Aging.  

The institute is enrolling 2,500 patients in a new study comparing the potential protective effects of two widely used drugs - naproxen, also known as Aleve, and the newer Celebrex - with dummy pills. Results are expected around 2008.  

Dr. John C.S. Breitner and Peter P. Zandi of Johns Hopkins University in Baltimore wrote in an accompanying editorial that the Dutch study  appears to resolve puzzling conflicts among previous studies on the topic.

  On the Net: New England Journal of Medicine
http://www.nejm.com

National Institute on Aging Alzheimer's site: 
http://www.alzheimers.org/

Alzheimer's Disease Anti-inflammatory Prevention Trial: http://www.2stopad.org 

 Volume 345:1515-1521, November 22, 2001,  Number 21

Nonsteroidal Antiinflammatory Drugs and the Risk of Alzheimer's Disease

 Bas A. in 't Veld, M.D., Ph.D., Annemieke Ruitenberg, M.D., Ph.D., Albert Hofman, M.D., Ph.D., Lenore J. Launer, Ph.D., Cornelia M. van Duijn, Ph.D., Theo Stijnen, Ph.D., Monique M.B. Breteler, M.D., Ph.D., and Bruno H.C. Stricker, M.B.,Ph.D.                                                         

ABSTRACT

Background Previous studies have suggested that the use of nonsteroidal antiinflammatory drugs (NSAIDs) may help to prevent Alzheimer's disease. The results, however, have been inconsistent.  

Methods We studied the association between the use of NSAIDs and Alzheimer's disease and vascular dementia in a prospective, population-based cohort study of 6989 subjects 55 years of age or older who were free of dementia at base line. The risk of Alzheimer's disease was estimated in relation to the use of NSAIDs as documented in pharmacy records. We defined four mutually exclusive categories of use: nonuse, short-term use (1 month or less of cumulative use), intermediate-term use (more than 1 but less than 24 months of cumulative use), and long-term use (24 months or more of cumulative use). Adjustments were made by Cox regression analysis for age, sex, education, smoking status, and the use or nonuse of salicylates, histamine H2-receptor antagonists, antihypertensive agents, and hypoglycemic agents.  

Results During an average follow-up period of 6.8 years, dementia developed in 394 subjects, of whom 293 had Alzheimer's disease, 56 vascular dementia, and 45 other types of dementia. The relative risk of Alzheimer's disease was 0.95 (95 percent confidence interval, 0.70 to 1.29) in subjects with short-term use of NSAIDs, 0.83 (95 percent confidence interval, 0.62 to 1.11) in those with intermediate-term use, and 0.20 (95 percent confidence interval, 0.05 to 0.83) in those with long-term use. The risk did not vary according to age. The use of NSAIDs was not associated with a reduction in the risk of vascular dementia.  

Conclusions The long-term use of NSAIDs may protect against Alzheimer's disease but not against vascular dementia.

Source Information

From the Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands (B.A.V., A.R., A.H., C.M.D., T.S., M.M.B.B., B.H.C.S.); the

Epidemiology, Demography, and Biometry Program, National Institute on Aging, National Institutes of Health, Bethesda, Md. (L.J.L.); and the Inspectorate for Health Care, The

Hague, the Netherlands (B.A.V., B.H.C.S.).  

Address reprint requests to Dr. Stricker at the Department of Epidemiology and Biostatistics, Erasmus Medical Center, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands.