***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To examine whether observed differences in dementia rates between black and white older people living in the community could be explained by measures of socioeconomic status ( income , financial adequacy , education , and literacy ) and health related factors . Design Prospect i ve cohort study . Setting General community from two clinic sites in the United States ( Pittsburgh , Pennsylvania and Memphis , Tennessee ) . Participants 2457 older people ( mean age 73.6 years ; 1019 ( 41.5 % ) black ; 1233 ( 50.2 % ) women ) , dementia-free at baseline , in the Health , Aging , and Body Composition study . Main outcome measure Dementia was determined over 12 years ( ending January 2011 ) by prescribed dementia drugs , hospital records , and decline in global cognitive scores . The influence of socioeconomic status and health related factors on dementia rates was examined in a series of Cox proportional hazard models in which these variables were added sequentially in covariate blocks . Results Over follow-up , 449 ( 18.3 % ) participants developed dementia . Black participants were more likely than white participants to develop dementia ( 211 ( 20.7 % ) v 238 ( 16.6 % ) , P<0.001 ; unadjusted hazard ratio 1.44 , 95 % confidence interval 1.20 to 1.74 ) . The hazard ratio lessened somewhat after adjustment for demographics , apolipoprotein E e4 , comorbidities , and lifestyle factors ( 1.37 , 1.12 to 1.67 ) but was greatly reduced and no longer statistically significant when socioeconomic status was added ( 1.09 , 0.87 to 1.37 ) . Conclusion These findings suggest that differences in the burden of risk factors , especially socioeconomic status , may contribute to the higher rates of dementia seen among black compared with white older people . Strategies aim ed at reducing these disparities may favorably affect the incidence of dementia Background and Purpose — Although aspirin is effective in prevention of stroke , fewer studies have examined the impact of aspirin on stroke morbidity . Methods — The Women ’s Health Study is a completed r and omized , placebo-controlled trial design ed to test the effect of low-dose aspirin and vitamin E in the primary prevention of cardiovascular disease and cancer , which enrolled 39 876 women . We used multinomial logistic regression to evaluate the relationship between r and omized aspirin assignment and functional outcomes from stroke . Possible functional outcomes were neither stroke nor transient ischemic attack ( TIA ) , modified Rankin scale ( mRS ) score 0 to 1 , 2 to 3 , and 4 to 6 . Results — After a mean of 9.9 years of follow-up , 460 confirmed strokes ( 366 ischemic , 90 hemorrhagic , and 4 unknown type ) and 405 confirmed TIAs occurred . With regard to total and ischemic stroke , women who were r and omized to aspirin had a nonsignificant decrease in risk of any outcome compared to women not r and omized to aspirin . This decrease in risk only reached statistical significance for those experiencing TIA compared to participants without stroke or TIA ( odds ratio=0.77 ; 95 % confidence interval , 0.63–0.94 ) . For hemorrhagic stroke , a nonsignificant increase in the risk of achieving an mRS score 2 to 3 or 4 to 6 compared with no stroke or TIA was observed for the women r and omized to aspirin compared to those r and omized to placebo . Conclusions — Results from this large r and omized clinical trial provide evidence that 100 mg of aspirin every other day may reduce the risk of ischemic cerebral vascular events but does not have differential effects on functional outcomes from stroke Objective To determine whether low dose aspirin protects women aged 65 or more against  cognitive decline . Design Cohort study within both arms of the women 's health study , a r and omised , double blind , placebo controlled trial of low dose aspirin for the primary prevention of cardiovascular disease and cancer , 1992 - 5 . Setting Women 's health study , 1998 - 2004 . Participants 6377 women aged 65 or more . Interventions Low dose aspirin ( 100 mg on alternate days ) or placebo for a mean of 9.6 years . Main outcome measures Women had three cognitive assessment s at two year intervals by telephone . The battery to assess cognition included five tests measuring general cognition , verbal memory , and category fluency . The primary prespecified outcome was a global score , averaging performance across all tests . The key secondary outcome was a verbal memory score , averaging performance on four measures of verbal memory . Results At the initial assessment ( mean 5.6 years after r and omisation ) cognitive performance in the aspirin group was similar to that of the placebo group ( mean difference in global score −0.01 , 95 % confidence interval −0.04 to 0.02 ) . Mean decline in the global score from the first to the final cognitive assessment was also similar in the aspirin compared with placebo groups ( mean difference 0.01 , −0.02 to 0.04 ) . The risk of substantial decline ( in the worst 10th centile of decline ) was also comparable between the groups ( relative risk 0.92 , 0.77 to 1.10 ) . Findings were similar for verbal memory ; however , a 20 % lower risk was observed for decline in category fluency with aspirin ( relative risk 0.80 , 0.67 to 0.97 ) . Conclusion Long term use of low dose aspirin does not provide overall benefits for cognition among generally healthy women aged 65 or more Background Amnestic mild cognitive impairment represents , in many cases , the earliest clinical phases of Alzheimer disease . Anti-inflammatory agents have epidemiologic support as drugs potentially beneficial in Alzheimer disease . In vivo studies have shown that Triflusal and its active metabolite 2-hydroxy-4-trifluoromethyl-benzoic acid have potent anti-inflammatory actions in the central nervous system . Methods We conducted a r and omized , double-blind , placebo-controlled trial of Triflusal in patients with amnestic mild cognitive impairment . Subjects were r and omly assigned to receive 900 mg of Triflusal or placebo for 18 months . The primary outcome was a change in Cognitive subscale of the Alzheimer Disease Assessment Scale ; conversion to dementia was a secondary outcome . Results A slow rate of recruitment forced a premature cessation of the study . Two hundred and fifty-seven subjects were enrolled and followed-up for an average of 13 months . The significance level was not reached for the primary outcome even though a trend in favor of Triflusal was observed . However , there was a significant difference in the probability of progression to dementia of Alzheimer 's type with a lower risk in the Triflusal compared with the placebo group ( hazard ratio , 2.10 ; 95 % confidence interval , 1.10 - 4.01 ; P=0.024 ) . Conclusions In this study , Triflusal therapy was associated with a significant lower rate of conversion to dementia that is likely to be clinical ly relevant . Because the trial was prematurely halted , these results should be interpreted with caution and require further confirmation BACKGROUND Selective inhibition of cyclooxygenase-2 ( COX-2 ) may be associated with an increased risk of thrombotic events , but only limited long-term data have been available for analysis . We report on the cardiovascular outcomes associated with the use of the selective COX-2 inhibitor rofecoxib in a long-term , multicenter , r and omized , placebo-controlled , double-blind trial design ed to determine the effect of three years of treatment with rofecoxib on the risk of recurrent neoplastic polyps of the large bowel in patients with a history of colorectal adenomas . METHODS A total of 2586 patients with a history of colorectal adenomas underwent r and omization : 1287 were assigned to receive 25 mg of rofecoxib daily , and 1299 to receive placebo . All investigator-reported serious adverse events that represented potential thrombotic cardiovascular events were adjudicated in a blinded fashion by an external committee . RESULTS A total of 46 patients in the rofecoxib group had a confirmed thrombotic event during 3059 patient-years of follow-up ( 1.50 events per 100 patient-years ) , as compared with 26 patients in the placebo group during 3327 patient-years of follow-up ( 0.78 event per 100 patient-years ) ; the corresponding relative risk was 1.92 ( 95 percent confidence interval , 1.19 to 3.11 ; P=0.008 ) . The increased relative risk became apparent after 18 months of treatment ; during the first 18 months , the event rates were similar in the two groups . The results primarily reflect a greater number of myocardial infa rct ions and ischemic cerebrovascular events in the rofecoxib group . There was earlier separation ( at approximately five months ) between groups in the incidence of nonadjudicated investigator-reported congestive heart failure , pulmonary edema , or cardiac failure ( hazard ratio for the comparison of the rofecoxib group with the placebo group , 4.61 ; 95 percent confidence interval , 1.50 to 18.83 ) . Overall and cardiovascular mortality was similar in the two groups . CONCLUSIONS Among patients with a history of colorectal adenomas , the use of rofecoxib was associated with an increased cardiovascular risk Objective To determine the effects of low dose aspirin on cognitive function in middle aged to elderly men and women at moderately increased cardiovascular risk . Design R and omised double blind placebo controlled trial . Setting Central Scotl and . Participants 3350 men and women aged over 50 participating in the aspirin for asymptomatic atherosclerosis trial . Intervention Low dose aspirin ( 100 mg daily ) or placebo for five years . Main outcome measures Tests of memory , executive function , non-verbal reasoning , mental flexibility , and information processing five years after r and omisation , with scores used to create a summary cognitive score ( general factor ) . Results At baseline , mean vocabulary scores ( an indicator of previous cognitive ability ) were similar in the aspirin ( 30.9 , SD 4.7 ) and placebo ( 31.1 , SD 4.7 ) groups . In the primary intention to treat analysis , there was no significant difference at follow-up between the groups in the proportion achieving over the median general factor cognitive score ( 32.7 % and 34.8 % respectively , odds ratio 0.91 , 95 % confidence interval 0.79 to 1.05 , P=0.20 ) or in mean scores on the individual cognitive tests . There were also no significant differences in change in cognitive ability over the five years in a subset of 504 who underwent detailed cognitive testing at baseline . Conclusion Low dose aspirin does not affect cognitive function in middle aged to elderly people at increased cardiovascular risk . Trial registration IS RCT N 66587262 Inflammatory mechanisms have been implicated in Alzheimer 's disease ( AD ) and might be mediated via the COX-2 enzyme . Previous studies with the selective COX-2 inhibitors , rofecoxib and celecoxib , have shown that they do not alter the progression of AD . We conducted a double-blind study to investigate whether rofecoxib could delay a diagnosis of AD in patients with mild cognitive impairment ( MCI ) , a group with an expected annual AD diagnosis rate of 10–15 % . MCI patients ⩾65 years were r and omized to rofecoxib 25 mg ( N=725 ) or placebo ( N=732 ) daily for up to 4 years . The primary end point was the percentage of patients with a clinical diagnosis of AD . The estimated annual AD diagnosis rate was lower than the anticipated 10–15 % : 6.4 % in the rofecoxib group vs 4.5 % in the placebo group ( rofecoxib : placebo hazard ratio=1.46 ( 95 % CI : 1.09 , 1.94 ) , p=0.011 ) . Analyses of secondary end points , including measures of cognition ( eg the cognitive subscale of the AD Assessment Scale ( ADAS-Cog ) ) and global function ( eg the Clinical Dementia Rating ( CDR ) ) , did not demonstrate differences between treatment groups . There was also no consistent evidence that rofecoxib differed from placebo in post hoc analyses comparing ADAS-Cog and CDR-sum of boxes scores in overlapping subgroups of patients who had Mini Mental State Exam scores of 24–26 in the present MCI study and in a previous AD treatment study with a similar design . The results from this MCI study did not support the hypothesis that rofecoxib would delay a diagnosis of AD . In conjunction with the lack of effects observed in previous AD studies , the findings suggest that inhibition of COX-2 is not a useful therapeutic approach in AD BACKGROUND Selective cyclooxygenase-2 ( COX-2 ) inhibitors have come under scrutiny because of reports suggesting an increased cardiovascular risk associated with their use . Experimental research suggesting that these drugs may contribute to a prothrombotic state provides support for this concern . METHODS We review ed all potentially serious cardiovascular events among 2035 patients with a history of col 
    Output:
    
There is no evidence to support the use of low-dose aspirin or other NSAIDs of any class ( celecoxib , rofecoxib or naproxen ) for the prevention of dementia , but there was evidence of harm .