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LETTERS TO THE EDITOR
Author Contributions: Chou: concept and design, drafting and revising article critically for important intellectual content, final approval of version to be published. Liang, Hsieh: design, drafting and revising article critically for important intellectual content, final approval of the version to be published. Chen, Chang: concept and design, revising article critically for important intellectual content. Hang: concept and design. Sponsor’s Role: None.
REFERENCES 1. Romero E, Krakow B, Haynes P et al. Nocturia and snoring: Predictive symptoms for obstructive sleep apnea. Sleep Breath 2010;14:337–343. 2. Yoshimura K. Correlates for nocturia: A review of epidemiological studies. Int J Urol 2012;19:317–329. 3. Bixler EO, Vgontzas AN, Ten Have T et al. Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med 1998;157:144–148. 4. Sullivan CE, Issa FG, Berthon-Jones M et al. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981;1:862–865. 5. Iber C, Ancoli-Israel S, Chesson A et al. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Darien, IL: American Academy of Sleep Medicine, 2007. 6. Margel D, Shochat T, Getzler O et al. Continuous positive airway pressure reduces nocturia in patients with obstructive sleep apnea. Urology 2006;67:974– 977.
REGULAR ASPIRIN USE DOES NOT REDUCE RISK OF COGNITIVE DECLINE To the Editor: Regular aspirin use is routinely recommended for protection against cerebrovascular and cardiovascular events. Although cerebrovascular pathology contributes to risk of dementia, it is not well established whether aspirin use attenuates this risk. Previous work has demonstrated that transient ischemic attack (TIA) or report of stroke-like symptoms is associated with risk of cognitive impairment in cross-sectional analyses1 and with incident cognitive decline during longitudinal follow-up2 in the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study.3 The objective of the current study was to determine whether regular aspirin use protects against incident cognitive decline according to REGARDS. REGARDS has enrolled 30,239 participants for whom extensive demographic and health data have been collected. Several cognitive assessments have occurred during longitudinal follow-up of the cohort. A measure of global cognitive status, the Six-Item Screener (SIS), has been administered annually since 2003. Additional cognitive measures were subsequently added to the protocol for consistency with the 5-minute neuropsychological battery that the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Harmonization Standards recommend.4 These tests, administered every 2 years, evaluate memory (Word List Learning (WLL) and Word List Recall (WLR)) and executive function (Animal Fluency Test (AFT) and Letter Fluency (LF)). Longitudinal SIS data were available for 23,915 participants who were cognitively normal at baseline (SIS > 4): 38% black, 43% female, mean age 64 9.2 at
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enrollment, average follow-up 5.9 years. Analyses of the SIS data indicate that those who did not use aspirin regularly had a higher likelihood of incident impairment according to the SIS (SIS < 5 on most-recent assessment) in univariate models (odds ratio (OR) = 1.11, 95% confidence interval (CI) = 1.09–1.13), but after adjustment for demographic factors, the association between regular aspirin use and incident impairment on the SIS was no longer significant (OR = 0.99, 95% CI = 0.89–1.09). Additional inclusion of Framingham Stroke Risk total scores or individual factors did not change this finding. For separate analyses of cognitive change on the WLL, WLR, AFT, and LF measures, difference scores were calculated based on each participant’s first and last assessments on each measure, adjusted for initial score values. There were 12,231 participants with longitudinal WLL data: 35% black, 56% female, mean age 64 8.4, average follow-up 3.6 years. In analysis of covariance models, the association between aspirin use and change in WLL score was significant before (Model 1) but not after adjustment for demographic characteristics (Model 2) or risk factors (Models 3 and 4). Analysis of the WLR data produced similar findings. The effect of adding each demographic variable individually was studied to understand the difference in association between aspirin use and change in WLL and WLR scores due to demographic factors, and it was found that age was the dominant factor responsible for the effect attenuation. Similar results were obtained for AFT and LF (Table 1). The protective effects of aspirin against heart disease and as a secondary preventive treatment for stroke are well
Table 1. Multivariable Results for Cognitive Change Scores According to Aspirin Use Cognitive Test
Model 1
Word List Learning (n = 12,231) Aspirin users 0.099 Nonaspirin users 0.418 P-value
LETTERS TO THE EDITOR
Author Contributions: Chou: concept and design, drafting and revising article critically for important intellectual content, final approval of version to be published. Liang, Hsieh: design, drafting and revising article critically for important intellectual content, final approval of the version to be published. Chen, Chang: concept and design, revising article critically for important intellectual content. Hang: concept and design. Sponsor’s Role: None.
REFERENCES 1. Romero E, Krakow B, Haynes P et al. Nocturia and snoring: Predictive symptoms for obstructive sleep apnea. Sleep Breath 2010;14:337–343. 2. Yoshimura K. Correlates for nocturia: A review of epidemiological studies. Int J Urol 2012;19:317–329. 3. Bixler EO, Vgontzas AN, Ten Have T et al. Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med 1998;157:144–148. 4. Sullivan CE, Issa FG, Berthon-Jones M et al. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981;1:862–865. 5. Iber C, Ancoli-Israel S, Chesson A et al. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Darien, IL: American Academy of Sleep Medicine, 2007. 6. Margel D, Shochat T, Getzler O et al. Continuous positive airway pressure reduces nocturia in patients with obstructive sleep apnea. Urology 2006;67:974– 977.
REGULAR ASPIRIN USE DOES NOT REDUCE RISK OF COGNITIVE DECLINE To the Editor: Regular aspirin use is routinely recommended for protection against cerebrovascular and cardiovascular events. Although cerebrovascular pathology contributes to risk of dementia, it is not well established whether aspirin use attenuates this risk. Previous work has demonstrated that transient ischemic attack (TIA) or report of stroke-like symptoms is associated with risk of cognitive impairment in cross-sectional analyses1 and with incident cognitive decline during longitudinal follow-up2 in the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study.3 The objective of the current study was to determine whether regular aspirin use protects against incident cognitive decline according to REGARDS. REGARDS has enrolled 30,239 participants for whom extensive demographic and health data have been collected. Several cognitive assessments have occurred during longitudinal follow-up of the cohort. A measure of global cognitive status, the Six-Item Screener (SIS), has been administered annually since 2003. Additional cognitive measures were subsequently added to the protocol for consistency with the 5-minute neuropsychological battery that the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Harmonization Standards recommend.4 These tests, administered every 2 years, evaluate memory (Word List Learning (WLL) and Word List Recall (WLR)) and executive function (Animal Fluency Test (AFT) and Letter Fluency (LF)). Longitudinal SIS data were available for 23,915 participants who were cognitively normal at baseline (SIS > 4): 38% black, 43% female, mean age 64 9.2 at
FEBRUARY 2015–VOL. 63, NO. 2
JAGS
enrollment, average follow-up 5.9 years. Analyses of the SIS data indicate that those who did not use aspirin regularly had a higher likelihood of incident impairment according to the SIS (SIS < 5 on most-recent assessment) in univariate models (odds ratio (OR) = 1.11, 95% confidence interval (CI) = 1.09–1.13), but after adjustment for demographic factors, the association between regular aspirin use and incident impairment on the SIS was no longer significant (OR = 0.99, 95% CI = 0.89–1.09). Additional inclusion of Framingham Stroke Risk total scores or individual factors did not change this finding. For separate analyses of cognitive change on the WLL, WLR, AFT, and LF measures, difference scores were calculated based on each participant’s first and last assessments on each measure, adjusted for initial score values. There were 12,231 participants with longitudinal WLL data: 35% black, 56% female, mean age 64 8.4, average follow-up 3.6 years. In analysis of covariance models, the association between aspirin use and change in WLL score was significant before (Model 1) but not after adjustment for demographic characteristics (Model 2) or risk factors (Models 3 and 4). Analysis of the WLR data produced similar findings. The effect of adding each demographic variable individually was studied to understand the difference in association between aspirin use and change in WLL and WLR scores due to demographic factors, and it was found that age was the dominant factor responsible for the effect attenuation. Similar results were obtained for AFT and LF (Table 1). The protective effects of aspirin against heart disease and as a secondary preventive treatment for stroke are well
Table 1. Multivariable Results for Cognitive Change Scores According to Aspirin Use Cognitive Test
Model 1
Word List Learning (n = 12,231) Aspirin users 0.099 Nonaspirin users 0.418 P-value
