A new large-scale UK study suggests that some widely used medications, including common painkillers, may not only alleviate physical symptoms but could also influence cognitive performance. Conducted by researchers at University College London (UCL), the study analysed data from over half a million individuals and found that ibuprofen and several other medications were associated with improved memory and reaction times.

Anti-Inflammatories and Brain Function

Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID) commonly used to treat pain, fever, and inflammation, was linked with enhanced reaction speed and cognitive performance. The effect size, according to researchers, was comparable to the benefits of managing high blood pressure – already known to support brain health.

Other pain-relieving medications including aspirin, codeine, and diclofenac were also associated with improved scores on tests assessing memory, reasoning, and problem-solving. Similarly, drugs such as omega-3 triglycerides (used in cardiovascular care), glucosamine (for osteoarthritis), atorvastatin (for cholesterol), and proton pump inhibitors like omeprazole and lansoprazole, also showed a positive relationship with cognitive function.

Cognitive Risks: Paracetamol and Fluoxetine

In contrast, the study found that paracetamol (acetaminophen) and fluoxetine (an SSRI antidepressant) were linked with poorer cognitive test performance. This finding is particularly significant given the widespread and often long-term use of these medications in both primary and secondary care settings.

Amitriptyline, a tricyclic antidepressant often prescribed for migraine or chronic pain, was associated with the most significant negative impact on cognition among the drugs analysed.

Study Design and Cautionary Notes

The study, published in Brain and Behaviour, is observational and does not establish causality. Researchers analysed medical and prescription data from over 540,000 adults up to age 73, comparing cognitive performance in users and non-users of commonly prescribed drugs. Tests assessed reaction time, memory, reasoning, and problem-solving.

While the associations are intriguing, the authors urge caution. Cognitive outcomes can be influenced by multiple variables including age, comorbidities, and polypharmacy. Many of the drugs in question are more frequently prescribed to older patients, making it challenging to isolate drug effects from age-related cognitive decline or medication interactions.

Call for Broader Cognitive Assessments in Drug Trials

The findings underscore the importance of including cognitive outcomes in clinical trials of commonly used medications. Lead author and neurologist Dr Martin Rossor emphasised that cognitive side-effects – both positive and negative – should be more routinely considered in clinical decision-making:

“Medications are widely employed, and many have adverse cognitive effects. Consideration should be given to a routine assessment of cognition in trials,” Rossor noted.

Clinical Implications

For clinicians, the study serves as a prompt to:

  • Monitor cognitive symptoms in patients on long-term medications
  • Consider cognitive impacts as part of the benefit-risk assessment when prescribing
  • Stay informed about emerging evidence on drug-cognition interactions, particularly in ageing populations

Given that nearly half of dementia cases could potentially be prevented through modifiable risk factors, the relationship between common medications and brain health is a promising area for further research.

 

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