Optimal treatment to prevent or delay cognitive decline, mild cognitive impairment (MCI), or dementia is uncertain.
To summarize current evidence on the efficacy and harms of pharmacologic interventions to prevent or delay cognitive decline, MCI, or dementia in adults with normal cognition or MCI.
Several electronic databases from January 2009 to July 2017, bibliographies, and expert recommendations.
English-language trials of at least 6 months' duration enrolling adults without dementia and comparing pharmacologic interventions with placebo, usual care, or active control on cognitive outcomes.
Two reviewers independently rated risk of bias and strength of evidence; 1 extracted data, and a second checked accuracy.
Fifty-one unique trials were rated as having low to moderate risk of bias (including 3 that studied dementia medications, 16 antihypertensives, 4 diabetes medications, 2 nonsteroidal anti-inflammatory drugs [NSAIDs] or aspirin, 17 hormones, and 7 lipid-lowering agents). In persons with normal cognition, estrogen and estrogen-progestin increased risk for dementia or a combined outcome of MCI or dementia (1 trial, low strength of evidence); high-dose raloxifene decreased risk for MCI but not for dementia (1 trial, low strength of evidence); and antihypertensives (4 trials), NSAIDs (1 trial), and statins (1 trial) did not alter dementia risk (low to insufficient strength of evidence). In persons with MCI, cholinesterase inhibitors did not reduce dementia risk (1 trial, low strength of evidence). In persons with normal cognition and those with MCI, these pharmacologic treatments neither improved nor slowed decline in cognitive test performance (low to insufficient strength of evidence). Adverse events were inconsistently reported but were increased for estrogen (stroke), estrogen-progestin (stroke, coronary heart disease, invasive breast cancer, and pulmonary embolism), and raloxifene (venous thromboembolism).
High attrition, short follow-up, inconsistent cognitive outcomes, and possible selective reporting and publication.
Evidence does not support use of the studied pharmacologic treatments for cognitive protection in persons with normal cognition or MCI.
Agency for Healthcare Research and Quality.
Pharmacology, Toxicology and Pharmaceutical Science
14
5%
Other
39
14%
Unknown
118
43%
Attention Score in Context
Attention Score in Context
This research output has an Altmetric Attention Score of 255. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 14 October 2025.
All research outputs
#182,842
of 34,411,289 outputs
Outputs from Annals of Internal Medicine
#845
of 16,869 outputs
Outputs of similar age
#3,305
of 493,508 outputs
Outputs of similar age from Annals of Internal Medicine
#12
of 143 outputs
Altmetric has tracked 34,411,289 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 99th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 16,869 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 57.7. This one has done particularly well, scoring higher than 94% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 493,508 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 99% of its contemporaries.
We're also able to compare this research output to 143 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 91% of its contemporaries.
