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Reference: Arvanitakis, 2008
Cohort: Religious Orders Study
Risk Factor: Non-Steroidal Anti-Inflammatory Drugs


Average Follow-up Time Detail
One thousand and nineteen participants had at least one year of follow-up (>95% follow-up rate). Of the 1,012 participants enrolled, 409 died during the study. Participants were followed for up to 12 years. Person-years were not reported, but the average follow-up time reported in other studies using this cohort indicate an average of 4-5 years of follow-up.

Exposure Detail
Interviewers ascertained the participants' drug use through direct visual inspection of all containers of prescription and over-the-counter agents at baseline and each annual follow-up evaluation. Medications were coded using the Medi-Span Drug Data Base system. The investigators reported results separately for always vs. never non-ASA NSAID use, current vs. not using non-ASA NSAIDs, always vs. never ASA use, and current vs. not using ASA. This entry pertains to results on the current vs. not using non-ASA NSAID.

The investigators compared AD risk in two groups: the group of participants who used non-ASA NSAIDs at baseline ("Current use") and the reference group of participants who did not use non-ASA NSAIDs at baseline ("Not using"); the reference group included participants who used aspirin.

Ethnicity Detail
The distribution of ethnicity is not reported, but of the entire Religious Orders Study cohort, 89% of the participants are Caucasian.

Screening and Diagnosis Detail
Screening Method:
CERADConsortium to Establish a Registry for Alzheimer's Disease (Morris 1989)
Neuropsych Testing

AD Diagnosis:
NINCDS ADRDA National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association Criteria (McKhann 1984)

Covariates & Analysis Detail
Analysis Type:
Cox proportional hazards regression

"Analyses were adjusted for age, sex, and education. We used Cox proportional hazards models to examine the relation of baseline nonaspirin NSAIDs (vs no baseline nonaspirin NSAIDs) to incident AD; the reference group included aspirin users. Because aspirin
was the most commonly used NSAID, we repeated the analysis for aspirin (vs no aspirin, including persons using other NSAIDs in the reference group) as the predictor. We addressed the issue of regularity of NSAID use in two ways. First, regularity of NSAID use was examined in analyses of the total history of NSAID use during follow-up, in which we updated the cumulative average NSAID use at each follow-up period for each of the three predictors (i.e., entered as a time-varying covariate in the model). Secondly, we conducted separate analyses (for each of the three predictors: baseline nonaspirin NSAIDs, ibuprofen, and aspirin) in which NSAIDs used less than daily were excluded."

AD Covariates:
Aage
Eeducation
Ggender