Therapeutic Guidelines for Antiinflammatory Medications

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For anti-inflammatory agents, a few broad guidelines are in order. Although steroids like prednisone have the strongest anti-inflammatory properties, these are fairly toxic compounds that are quite tricky to use. In addition, the negative results in the recent Alzheimer's study have convinced me to exclude steroids from the Memory Program.

Among the NSAIDs, the antioxidant and anticoagulant properties of aspirin give it a slight edge over the other available compounds. If you have risk factors for stroke or heart attack—for example, a strong family history or a high cholesterol blood level—an aspirin a day is a good idea. It may also protect against memory loss, given its antistroke and anti-inflammatory properties. Other NSAIDs like ibuprofen (Motrin) or indomethacin (Indocin) also irritate the stomach lining, though to a lesser extent than aspirin (enteric-coated or buffered aspirin helps but does not always solve the problem). The other NSAIDs do not share aspirin's anticoagulant properties that help reduce the risk of stroke and heart attacks.

Our best hope for the use of anti-inflammatory agents to prevent memory loss lies with the new COX-II inhibitors. We should know about the results of the Merck and Searle trials to treat mild to moderate memory loss within the next couple of years, and if they are positive, these medications could become the linchpin of a therapeutic strategy against memory loss due to the aging process. The relative lack of side effects will allow most people to take these medications without difficulty. Stay tuned for the results of the COX-II inhibitor trials in people with mild to moderate memory loss.

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