Intervention Review

Aspirin for vascular dementia

  1. Gianetta Rands1,*,
  2. Martin Orrell2,
  3. Aimee E Spector3

Editorial Group: Cochrane Dementia and Cognitive Improvement Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 19 MAY 2008

DOI: 10.1002/14651858.CD001296

Database Title

Additional Information

How to Cite

Rands G, Orrell M, Spector AE. Aspirin for vascular dementia. Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD001296. DOI: 10.1002/14651858.CD001296.

Author Information

  1. 1

    Camden and Islington NHS Foundation Trust, London, UK

  2. 2

    University College London, Department of Mental Health Sciences, London, UK

  3. 3

    Chesham, Buckinghamshire, UK

*Gianetta Rands, Camden and Islington NHS Foundation Trust, Highgate Mental Health Centre, Dartmouth Park Hill, London, N19 5NX, UK. grands@doctors.org.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 8 OCT 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Aspirin is widely prescribed for patients with a diagnosis of vascular dementia; in one study, completed by geriatricians and psychiatrists in the UK, 80% of patients with clinical diagnoses of vascular dementia 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, behaviour, or improve prognosis? In addition, does the risk of cerebral or gastric haemorrhage outweigh any benefit?

Objectives

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

Search methods

The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS were searched on 5 January 2008 using the terms: aspirin OR vascu* OR multi-infarct. The CDCIG Specialized Register contains records from all major health care databases (CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS) as well as from many trials databases and grey literature sources.

In addition, relevant web sites were searched and some journals were hand searched. Specialists in the field were approached for unpublished material and any publications found were searched for additional references.

Selection criteria

All randomized 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.

Data collection and analysis

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 is to evaluate data recorded via tools assessing cognitive and behavioural changes along with mortality, morbidity and institutionalization data.

Main results

No trials are eligible for inclusion in this review.

Authors' conclusions

The most recent search for references to relevant research was carried out in January 2008, but no new trials were found for inclusion.

There is still no good 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 on other outcomes such as morbidity, mortality, institutionalization, behaviour and quality of life. At present there is no evidence relating to other queries about the use of aspirin for dementia (these are described in the Background section of this review).

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

No evidence for the efficacy of aspirin for people with vascular dementia

Vascular dementia results from changes in the blood supply to the brain. This may occur from blockages in the arterial and/or capillary systems. Aspirin decreases TXA2 synthesis without significantly reducing prostacyclin synthesis thus causing reduced platelet aggregation and peripheral vasodilation. Aspirin has been shown to be useful in the management of stroke and is widely prescribed for patients with vascular dementia. It may increase the risk of haemorrhage, potentially worsening the outcome in both conditions. There is no good empirical evidence that aspirin affects cognition and improves the prognosis of people with vascular dementia.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

使用阿斯匹靈來治療血管型失智症

阿斯匹靈是一種十分普遍使用於治療血管型失智症的處方用藥，有一個由英國老年醫學家和精神病學家完成的研究中提及，大約有80％在臨床上被診斷出患有血管型失智症的患者都會被開立阿斯匹靈的處方，但是，這其中仍有許多問題仍待解答，例如：是否有明確的證據可以說明阿斯匹靈有助於血管型失智症？阿斯匹靈是否會影響認知、行為或是病情的發展？此外，使用阿斯匹靈是否具有超過引發腦部或是腸胃出血風險之外的好處？

目標

本研究的主要目的在於評估使用阿斯匹靈治療血管型失智症功效的證據。

搜尋策略

在2005年7月20日使用「aspirin和"vascu*或multiinfarc"」等關鍵字針對Specialized Register of the Cochrane Dementia and Cognitive Improvement Group資料庫進行檢索以確認可以納入研究的試驗，這個資料庫包含有所有主要醫學資料庫、主要試驗資料庫中的資料，並且會進行定期的更新，此外，也會針對相關的網站和期刊進行手動檢索，並與相關領域的專家聯繫以取得未公開的資料，如果是已公開的資料，也會更進一步的檢索其他的參考文獻資料。

選擇標準

所有探討使用阿斯匹靈對血管型失智症影響的隨機性對照試驗都會被納入本研究中，試驗被納入或排除是根據試驗設計品質和風險偏差進行系統性的評估來加以決定。

資料收集與分析

由2位審閱者分別針對資料利用預先試驗數據萃取格式進行萃取，有必要的時候，也會聯繫試驗作者以取得期刊中未揭露的數據，主要是希望能夠透過評估認知和行為改變和死亡率、發病率和住院率(institutionalization)的數據來評估數據記錄。

主要結論

本研究中並沒有發現適合納入研究的試驗。

作者結論

最近一次針對參考文獻進行的檢索顯示相關的研究都發生在2005年7月，但是並沒有發現更新的試驗資料，檢索也沒有發現有關於說明阿斯匹靈對於治療血管型失智症患者的良好證據，因此需要更多的研究來評估阿斯匹靈對於認知和其他例如死亡率、發病率、住院率、行為和生活品質等試驗成果的治療成果數據，目前也沒有使用阿斯匹靈治療失智症的其他相關評量結果的證據(這些敘述記錄在本研究的研究背景欄位中)。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有證據可以說明阿斯匹靈對於治療血管型失智症的有效性。血管型失智症的發生起因於對腦部的血液輸送改變所致，這可能是因為動脈和/或微血管系統發生阻塞，阿斯匹靈可以在沒有明顯降低前列環素(prostacyclin)的合成下降低TXA2合成，因此可以降低血小板的聚集和擴張末稍血管，阿斯匹靈已經顯示對於治療中風的功效，並且被很多醫師作為血管型失智症的處方用藥，這可能會增加出血的風險，這對於治療中風或是血管型失智症來說都是潛在性的危害，並沒有良好的經驗證據可以說明阿斯匹靈對於血管型失智症患者的認知功能和改善病患預後的影響。

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