IT SEEMS almost too good to be true. Regularly taking a simple
over-the-counter drug can stave off the crippling mental illness Alzheimer’s
disease.
A major study of thousands of elderly patients in the Netherlands has shown
that taking an average of just two anti-inflammatory pills a week reduces a
person’s risk of developing Alzheimer’s by 80 per cent. Yet a decade after the
first hints that drugs like the common painkiller ibuprofen could fend off the
disease, middle-aged people are not being encouraged to take the pills
regularly.
The reason is that non-steroidal anti-inflammatory drugs such as ibuprofen
cause serious stomach problems if taken regularly, says Bruno Stricker of the
Erasmus Medical Centre in Rotterdam. “I would call these drugs quite
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Other common anti-inflammatories called Cox-1 inhibitors interfere with a
stomach enzyme called cyclooxygenase 1. That can lead to severe intestinal
bleeding. “If you were to give everyone who was elderly non-steroidals you’d
kill more people than you’d save,” says Richard Harvey, director of research for
the Alzheimer’s Society in London.
But a new generation of similar pills, dubbed Cox-2 inhibitors, have the same
anti-inflammatory properties without upsetting the gut. A way of preventing
Alzheimer’s may finally be on the cards—although the drugs have yet to
prove themselves.
Stricker and his team are the first to look at the effects of
anti-inflammatories on such a large group of healthy adults. Because the drugs
were only available on prescription in the Netherlands for most of the study
period between 1991 and 1998, they also had a day-by-day account of their
volunteers’ drug use. Past studies have relied on patients to describe the
medicines they were taking, a notoriously unreliable method once dementia
strikes.
The results show a steady decline in the incidence of Alzheimer’s as people
took the drugs, from a 5 per cent reduction in risk for those taking pills for
30 days or less over the seven years, to an 80 per cent reduction for those
popping pills for more than two years overall out of the seven. That means you
could cut the number of people worldwide expected to get Alzheimer’s between now
and 2025 from 9 million to 2 million, just by having everyone take 2 pills a
week.
The drugs may break up the amyloid plaques that accumulate in the brains of
Alzheimer’s patients. Their anti-inflammatory properties may also help prevent
immune cells called macrophages from attacking healthy brain
cells—Stricker’s work and other studies indicate that the drugs work best
as a preventative medicine rather than a cure.
A Cox-2 inhibitor called Celecoxib, used to treat arthritis, failed a
clinical trial against Alzheimer’s on patients already diagnosed with the
disease. But a massive trial started this January by the US National Institute
on Aging will test it and another anti-inflammatory in a randomised, controlled
trial with healthy elderly people.
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More at:
The New England Journal of Medicine (vol 345, p 1515)