Epidemiologic Reviews 24:248-268 (2002)
© 2002 by the Johns Hopkins Bloomberg School of Public Health
Pharmacologic Agents Associated with a Preventive Effect on Alzheimer’s Disease: A Review of the Epidemiologic Evidence
1 Department of Epidemiology and Biostatistics, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands. 2 Drug Safety Unit, Inspectorate for Health Care, Den Haag, the Netherlands. 3 Department of Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands. 4 Epidemiology, Demography and Biometry Program, National Institute on Aging, Bethesda, MD.
Received for publication April 3, 2000; accepted for publication May 20, 2002.
Abbreviations: COX, cyclooxygenase; GABA, 
-aminobutyric acid; HMG-CoA, 3-hydroxy-3-methyglutaryl coenzyme A; HRT, hormone replacement therapy; H2, histamine 2; NSAID, nonsteroidal anti-inflammatory drug.
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INTRODUCTION |
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Alzheimer’s disease is the most common subtype of dementia. This disease is diagnosed in approximately two thirds of all cases of dementia (1). According to current diagnostic criteria, a diagnosis of Alzheimer’s disease is considered probable when alternative causes of dementia have been excluded (2, 3). A clinical diagnosis of dementia is often made according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) criteria for dementia, with a subdiagnosis of Alzheimer’s disease made according to the National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer’s Disease and Related Disorders Association (NINCDS-ADRDA) criteria (2). The pathogenesis of Alzheimer’s disease is largely unknown. In short, the most frequently used explanation is that unknown genetic or environmental factors initiate a cascade of neuropathologic events that feature accumulation of ß-amyloid and neurofibrillary tangles. This process is clinically characterized by a long
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METHODS |
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EPIDEMIOLOGY OF DRUGS IN THE ONSET OF ALZHEIMER’S DISEASE |
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NSAIDs and aspirin
Biologic rationale. Studies with prevalent cases. Studies with incident cases. Clinical trials. Glucocorticoids and other anti-inflammatory drugs
Biologic rationale. Studies with prevalent cases. Clinical trials. HRT
Biologic rationale. Studies with prevalent cases. Studies with incident cases. Clinical trials. H2-receptor blocking agents
Biologic rationale. Studies with prevalent cases. Antihypertensives
Biologic rationale. Studies with incident cases. Clinical trials. Lipid-lowering drugs
Biologic rationale. Studies with prevalent cases. Clinical trials. Benzodiazepines
Biologic rationale. Studies with prevalent cases. Studies with incident cases. Free-radical scavengers
Biologic rationale. Studies with incident cases. Clinical trials.
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DISCUSSION |
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Methodological considerations
Prevalent or incident cases. Selection bias, information bias, and confounding. Conclusions
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