Teratogenic effects of radiofrequency electromagnetic radiation on the embryonic development of chick: A study on morphology and hatchability.

The present study was aimed at studying the effects of RF-EMR in causing teratogenic changes in the embryonic development of organisms using chick embryo as a model. The fertilized eggs of the hen were incubated in a digital humidified incubator and exposed to RF-EMR from 2G and 4G mobile phones by ringing at regular time intervals. The dose of RF-EMR was varied by increasing the call duration and number of calls per day, with the lower dose being a call duration of 50 min/day and the higher dose being 90 min/day. The phone kept had a range of radiofrequency between 900 and 1800 MHz and SAR (Specific Absorption Rate) 1.355 (2G) and 1.12 (4G) watts/ kg respectively. The batch of eggs incubated without any exposure to RF-EMR was taken as control. The hatchability of 2G and 4G experimental groups were respectively, 65% and 75% at lower radiation exposure and 40% and 55% at higher radiation exposure. The teratogenic effects of RF-EMR on the morphology of chick embryos manifested as the cross beak, non-retracted yolk sac, macrocephaly, malformed legs and toes, disability in standing and balancing the body and variations in body weight, body length and beak length. The results indicate that the RF-EMR poses potential threats to the developing stages of organisms.

Antixenosis by a resistant Musa cultivar to stem borer Odoiporus longicollis attack and expression of microsomal α-amylase by the pest.

Banana pseudo-stem weevil (BPW) Odoiporus longicollis Olivier is a serious pest of Musa cultivars which completes its lifecycle as an internal parasite in the pseudo-stem of susceptible host plants. The larval stage of BPW is destructive and difficult to control as larvae are endophytic. Plantains (bananas), resistant to infestation by BPW, exhibited antixenosis against the larvae. Experimental maintenance of the larvae for 4 days in the live pseudo-stem of the resistant plantain resulted in the disruption of carbohydrate metabolism and imbalance of protein-free amino acid turnover. The pseudo-stem possesses three larvicides: stigmasterol-3-O-glucoside (SOG), sulfoquinovosyl diacylglycerol (SQDG), and betulinic acid (BA). Larvicides cause significant elevation in hemolymph protein and reduction in total free amino acids. Larvae treated with larvicides showed elevated activities of hexokinase, trehalase, and lactic acid dehydrogenase, which resulted in significant decrease of glucose and trehalose but sharp increase of lactic acid. Also, inhibition in the activity of glycogen phosphorylase caused significant increase of fat body glycogen in affected larvae. At LD20 concentration, toxicities by SOG, SQDG, and BA were similar but antixenosis by the resistant host plant was more severe due to the simultaneous action of three larvicides present in the resistant, live pseudo-stem. Disruption of carbohydrate metabolism and imbalance of protein-amino acid turnover due to toxicity by larvicides resulted in slow death of the larvae. The larval body responded against toxicity through the induction of the amy gene, which resulted in increased synthesis of α-amylase. The protein was sequenced as ID AHN 92452.2 with 496 amino acids, and the gene has 1491 nucleotides. Defense mechanisms by the larvae are not sufficient to resist antixenosis by the host plant. SOG, SQDG, and BA can be used synergistically as a larvicide for the control of BPW.

Consensus exercise identifying priorities for research in the field of general surgery of childhood in the UK.

BACKGROUND: The evidence base underlying clinical practice in children's general surgery is poor and high-quality collaborative clinical research is required to address current treatment uncertainties. The aim of this study was, through a consensus process, to identify research priorities for clinical research in this field amongst surgeons who treat children. METHODS: Questions were invited in a scoping survey amongst general surgeons and specialist paediatric surgeons. These were refined by the study team and subsequently prioritized in a two-stage modified Delphi process. RESULTS: In the scoping survey, a total of 226 questions covering a broad scope of children's elective and emergency general surgery were submitted by 76 different clinicians. These were refined to 71 research questions for prioritization. A total of 168 clinicians took part in stage one of the prioritization process, and 157 in stage two. A 'top 10' list of priority research questions was generated for both elective and emergency general surgery of childhood. These cover a range of conditions and concepts, including inguinal hernia, undescended testis, appendicitis, abdominal trauma and enhanced recovery pathways. CONCLUSION: Through consensus amongst surgeons who treat children, 10 priority research questions for each of the elective and emergency fields have been identified. These should provide a basis for the development of high-quality multicentre research projects to address these questions, and ultimately improve outcomes for children requiring surgical care.

Isolation, characterization and mode of action of a larvicidal compound, 22-hydroxyhopane from Adiantum latifolium Lam. against Oryctes rhinoceros Linn.

Oryctes rhinoceros Linn. is one of the most serious pests of coconuts and other palms. Following bioassay guided method, a larvicidal compound, 22-hydroxyhopane has been isolated for the first time from methanol extract of leaves of Adiantum latifolium Lam. against the pest (LC50 value 20.81 µg/g). It is a hopanoid triterpene with molecular mass of 442.42 g/mol. The compound exhibited antibacterial activity against symbiotic gut bacteria, caused histolysis of midgut tissues and inhibited secretion of digestive enzymes such as protease, amylase and trehalase resulting in weight loss of larvae. Enzyme immunoassay showed an elevation of 20-hydroxyecdysone level in haemolymph causing disruption of metamorphosis of larvae.

Culex quinquefasciatus Say larva adapts to temperature shock through changes in protein turn over and amino acid catabolism.

Exposure of Culex quinquefasciatus larvae to hypothermia or hyperthermia in relation to ecological temperature has resulted in alteration of enzyme activities related to maintenance of free amino acid pool and protein degradation. Sudden changes in water temperature have led to elevation of protein content particularly in molecular weight between 66 and 97.4 kDa. MALDI TOF analysis revealed the presence of putative uncharacterized protein and Phospholipase A2 activating protein in larvae subjected to 40°C for 1 hour which was not found in control and other temperature treated larvae. These proteins may be playing a role in survival of larvae at higher temperatures. Thermal shock has resulted in channeling of free amino acids for protein synthesis and elevation of amino acid catabolism through increased deamination and altered transamination, which resulted in a sharp decrease in free amino acid pool. Inhibition of Leucine amino peptidase and elevation of Cathepsin D, under the influence of thermal shock may be an adaptive response of larvae to prevent unnecessary degradation of protein and at the same time facilitated rapid internal re-organization which may accelerate pupation. Elevated activity of Phenol oxidase and its co-stimulator Trypsin -like Serine protease, along with increased expression of Phospholipase A2 activating protein is a well co-ordinated defense mechanism leading to increased immune response in stressed state. This study assumes significance because variation in environmental conditions such as global warming and their impact on mosquito physiology can influence efficiency of disease vector.

Perineal closure following extralevator abdominoperineal excision for cancer of the rectum.

AIM: Extralevator abdominoperineal resection (ELAPE) may be complicated by perineal wound healing problems and herniation. We report a consecutive series of 38 such patients with selective use of a fasciocutaneous V-Y buttock advancement flap (BAF). METHOD: Data were collected on a series of patients undergoing ELAPE for rectal malignancy between August 2011 and July 2017. Demographics, management and outcomes were recorded prospectively. Perineal wound problems were considered as 'major' if they required packing; otherwise, they were classed as 'minor'. RESULTS: Thirty-eight patients [eight female and 30 male; median age 63 (range: 35-89) years] underwent ELAPE. Thirty-seven had an adenocarcinoma of the rectum and one had a malignant melanoma. The median tumour height (from the anal verge) was 30 (range: 0-80) mm. Sixteen patients had a BAF. The median length of stay was 10 (range: 6-25) days. Primary perineal healing occurred in 18 (47%) patients. Major wound breakdown occurred in three (10%) patients and minor wound breakdown in 17 (45%). Two of the 16 patients having a BAF had major wound breakdown: one wound took 9 weeks to heal completely and the other took 9 months. Of the 22 patients who did not have a BAF, one had a major wound breakdown which closed by 3 months. There were no perineal fistulae or chronic sinuses. There were two perineal herniae that were successfully repaired by perineal insertion of biological mesh (Permacol™; Covidien, Dublin, Ireland). CONCLUSIONS: Selective use of a BAF for perineal closure can give good results in terms of healing and an acceptably low early perineal herniation rate.

Retention of laryngoscopy skills in medical students: a randomised, cross-over study of the Macintosh, A.P. Advance(™) , C-MAC(®) and Airtraq(®) laryngoscopes.

In addition to being effective and easy to learn how to use, the ideal laryngoscope should be associated with minimal reduction in skill performance during gaps in practice over time. We compared the time taken to intubate the trachea of a manikin by novice medical students immediately after training, and then after 1 month, with no intervening practice. We designed a two-period, four-group, randomised, cross-over trial to compare the Macintosh, Venner(™) A.P. Advance(™) with difficult airway blade, C-MAC(®) with D-Blade and Airtraq(®) with wireless video-viewer. A bougie was used to aid intubation with the Macintosh and the C-MAC. After training, there was no significant difference in median (IQR [range]) intubation time using the videolaryngoscopes compared with the Macintosh, which took 30 (26.5-35 [12-118])s. One month later, the intubation time was longer using the C-MAC (41 (29.5-52 [20-119])s; p = 0.002) and A.P. Advance (40 (28.5-57.5 [21-107])s; p = 0.0003)m compared with the Macintosh (27 (21-29 [16-90])s); there was no difference using the Airtraq (27 (20.5-32.5 [15-94])s; p = 0.258) compared with the Macintosh. While skill acquisition after a brief period of learning and practice was equal for each laryngoscope, performance levels differed after 1 month without practice. In particular, the consistency of performance using the C-MAC and A.P. Advance was worse compared with the Macintosh and the Airtraq. While the clinical significance of this is doubtful, we believe that reliable and consistent performance at laryngoscopy is desirable; for the devices that we tested, this requires regular practice.

Cadaveric study of movement of an unstable atlanto-axial (C1/C2) cervical segment during laryngoscopy and intubation using the Airtraq(®) , Macintosh and McCoy laryngoscopes.

Concern that laryngoscopy and intubation might create or exacerbate a spinal cord injury has generated extensive research into cervical spinal movement during laryngoscopy. We performed a randomised trial on six cadavers, using three different laryngoscopes, before and after creating a type-2 odontoid peg fracture. Our primary outcome measure was the change in the space available for the spinal cord at the C1/2 segment measured by cinefluoroscopy. Tracheal intubation was performed using a minimal view of the glottis, a bougie, and manual in-line stabilisation. In a cadaveric model of type-2 odontoid fracture, the space available for the cord was preserved in maximum flexion and extension, and changed little on laryngoscopy and intubation.

Mediterranean diet and depressive symptoms among older adults over time.

OBJECTIVE: To examine whether adherence to a Mediterranean-based dietary pattern is predictive of depressive symptoms among older adults. DESIGN: Generalized estimating equation models were used to test the association between a Mediterranean-based dietary pattern and depressive symptoms over time. Models were adjusted for age, sex, race, education, income, widowhood, antidepressant use, total calorie intake, body mass index, smoking, alcohol consumption, number of self-reported medical conditions, cognitive function, and physical disability. SETTING: Chicago, Illinois. PARTICIPANTS: Community-dwelling participants (n=3502) of the Chicago Health and Aging Project aged 65+ years (59% African American) who had no evidence of depression at the baseline. MEASUREMENTS: Adherence to a Mediterranean-based dietary pattern was assessed by the MedDietScore. Dietary evaluation was performed with a food frequency questionnaire at baseline and related to incident depression as measured by the presence of four or more depressive symptoms from the 10-item version of the Center for Epidemiologic Studies Depression scale. RESULTS: Over an average follow-up of 7.2 years, greater adherence to a Mediterranean-based diet was associated with a reduced number of newly occurring depressive symptoms (parameter estimate = -0.002, standard error = 0.001; p = 0.04). The annual rate of developing depressive symptoms was 98.6% lower among persons in the highest tertile of a Mediterranean-based dietary pattern compared with persons in the lowest tertile group. CONCLUSION: Our results support the hypothesis that adherence to a diet comprised of vegetables, fruits, whole grains, fish, and legumes may protect against the development of depressive symptoms in older age.

Cognitive decline after hospitalization in a community population of older persons.

OBJECTIVE: To test the hypothesis that hospitalization in old age is associated with subsequent cognitive decline. METHODS: As part of a longitudinal population-based cohort study, 1,870 older residents of an urban community were interviewed at 3-year intervals for up to 12 years. The interview included a set of brief cognitive tests from which measures of global cognition, episodic memory, and executive function were derived. Information about hospitalization during the observation period was obtained from Medicare records. RESULTS: During a mean of 9.3 years, 1,335 of 1,870 persons (71.4%) were hospitalized at least once. In a mixed-effects model adjusted for age, sex, race, and education, the global cognitive score declined a mean of 0.031 unit per year before the first hospitalization compared with 0.075 unit per year thereafter, a more than 2.4-fold increase. The posthospital acceleration in cognitive decline was also evident on measures of episodic memory (3.3-fold increase) and executive function (1.7-fold increase). The rate of cognitive decline after hospitalization was not related to the level of cognitive function at study entry (r = 0.01, p = 0.88) but was moderately correlated with rate of cognitive decline before hospitalization (r = 0.55, p = 0.021). More severe illness, longer hospital stay, and older age were each associated with faster cognitive decline after hospitalization but did not eliminate the effect of hospitalization. CONCLUSION: In old age, cognitive functioning tends to decline substantially after hospitalization even after controlling for illness severity and prehospital cognitive decline.

Vitamin B12, cognition, and brain MRI measures: a cross-sectional examination.

OBJECTIVE: To investigate the interrelations of serum vitamin B12 markers with brain volumes, cerebral infarcts, and performance in different cognitive domains in a biracial population sample cross-sectionally. METHODS: In 121 community-dwelling participants of the Chicago Health and Aging Project, serum markers of vitamin B12 status were related to summary measures of neuropsychological tests of 5 cognitive domains and brain MRI measures obtained on average 4.6 years later among 121 older adults. RESULTS: Concentrations of all vitamin B12-related markers, but not serum vitamin B12 itself, were associated with global cognitive function and with total brain volume. Methylmalonate levels were associated with poorer episodic memory and perceptual speed, and cystathionine and 2-methylcitrate with poorer episodic and semantic memory. Homocysteine concentrations were associated with decreased total brain volume. The homocysteine-global cognition effect was modified and no longer statistically significant with adjustment for white matter volume or cerebral infarcts. The methylmalonate-global cognition effect was modified and no longer significant with adjustment for total brain volume. CONCLUSIONS: Methylmalonate, a specific marker of B12 deficiency, may affect cognition by reducing total brain volume whereas the effect of homocysteine (nonspecific to vitamin B12 deficiency) on cognitive performance may be mediated through increased white matter hyperintensity and cerebral infarcts. Vitamin B12 status may affect the brain through multiple mechanisms.

Elder abuse and mortality: the role of psychological and social wellbeing.

BACKGROUND: Elder abuse is a pervasive human right and public health issue. OBJECTIVES: We aimed to examine the mortality associated with elder abuse across levels of psychological and social factors. METHODS: The Chicago Health and Aging Project (CHAP) is a prospective population-based cohort study that began in 1993. A subset of these participants enrolled between 1993 and 2005 had elder abuse reported to social services agencies (n = 113). Mortality was ascertained during follow-up and with the National Death Index. Psychosocial factors (depression, social network and social engagement) were assessed during the CHAP interview. Cox proportional hazard models were used to assess the mortality of elder abuse across levels of psychosocial factors using time-varying covariate analyses. RESULTS: The median follow-up time for the cohort (n = 7,841) was 7.6 years (interquartile range 3.8-12.4 years). In multivariate analyses, those with highest (hazard ratio (HR) 2.60, 95% CI 1.58-4.28) and middle levels (HR 2.18, 95% CI 1.19-3.99) of depressive symptoms had an increased mortality risk associated with elder abuse. For social network, those with lowest (HR 2.50, 95% CI 1.62-3.87) and middle levels (HR 2.65, 95% CI 1.52-4.60) of social network had increased mortality risk associated with elder abuse. For social engagement, those with lowest (HR 2.32, 95% CI 1.47-3.68) and middle levels (HR 2.59, 95% CI 1.65-5.45) of social engagement had increased mortality risk associated with elder abuse. Among those with lowest levels of depressive symptoms, highest levels of social network and social engagement, there was no significant effect of reported or confirmed elder abuse on mortality risk. CONCLUSION: Mortality risk associated with elder abuse was most prominent among those with higher levels of depressive symptoms and lower levels of social network and social engagement.

Cognitive activity and the cognitive morbidity of Alzheimer disease.

OBJECTIVE: To test the hypothesis that frequent cognitive activity predicts slower cognitive decline before dementia onset in Alzheimer disease (AD) and faster decline thereafter. METHODS: As part of a longitudinal cohort study, older residents of a geographically defined population were assessed at 3-year intervals with brief cognitive performance tests from which a composite measure of global cognition was derived. After each wave of testing, a subset was sampled for clinical evaluation. The present analyses are based on 1,157 participants. They were free of dementia at study enrollment at which time they rated frequency of participation in common cognitively stimulating activities from which a previously validated summary measure was derived. They were sampled for clinical evaluation a mean of 5.6 years after enrollment and subsequently followed a mean of 5.7 years with brief cognitive performance testing at 3-year intervals. RESULTS: On clinical evaluation, 614 people had no cognitive impairment, 395 had mild cognitive impairment, and 148 had AD. During follow-up, the annual rate of global cognitive decline in persons without cognitive impairment was reduced by 52% (estimate = 0.029, SE = 0.010, p = 0.003) for each additional point on the cognitive activity scale. In the mild cognitive impairment group, cognitive decline rate was unrelated to cognitive activity (estimate = -0.019, SE = 0.018, p = 0.300). In AD, the mean rate of decline per year increased by 42% (estimate = 0.075, SE = 0.021, p < 0.001) for each point on the cognitive activity scale. CONCLUSION: Mentally stimulating activity in old age appears to compress the cognitive morbidity associated with AD by slowing cognitive decline before dementia onset and hastening it thereafter.

Change in risk of Alzheimer disease over time.

OBJECTIVE: To assess whether the risk of incidence of Alzheimer disease (AD) varies over time. The increase in numbers of people at the oldest ages in the population will bring an increase in the number of people with AD. Projections of the size of the increase assume the risk of AD is constant. METHODS: All persons age 65 or older in a biracial, geographically defined area were invited to participate in a home interview every 3 years. From the approximately 10,000 participants, stratified random samples were selected for detailed clinical evaluation. At each cycle, individuals determined free of AD in a previous cycle, either by examination or by high score on cognitive function tests, were sampled in the subsequent cycle for evaluation for incident AD. The evaluations for disease were structured and uniform across time. These analyses include 1,695 subjects evaluated for incident disease from 1997 through 2008. RESULTS: AD developed in 360 participants. Change over time in risk of incident disease was assessed in logistic regression analyses including evaluation date and controlling for age, gender, education, race, interval from disease-free designation to evaluation for incident disease, and sample design. The time variable (in years) was not significant (odds ratio = 0.970, 95% confidence interval = 0.902 to 1.044). CONCLUSIONS: The null relation of evaluation date to disease incidence suggests no recent change in risk of AD over time, and supports this assumption for projections of AD.

Temporal course of depressive symptoms during the development of Alzheimer disease.

OBJECTIVE: To characterize change in depressive symptoms before and after the onset of dementia in Alzheimer disease (AD). METHOD: We used data from the Chicago Health and Aging Project, a longitudinal cohort study of risk factors for AD in a geographically defined population of old people. Two subsets were analyzed. In 357 individuals who developed incident AD during the study, self-report of depressive symptoms (Center for Epidemiologic Studies Depression Scale) was obtained at 3-year intervals for a mean of 8 to 9 years. In 340 individuals who agreed to annual data collection, informant report of depressive symptoms (Hamilton Depression Rating Scale) was obtained for a mean of 3 years after a diagnosis of AD (n = 107), mild cognitive impairment (n = 81), or no cognitive impairment (n = 152). RESULTS: The incident AD group reported a barely perceptible increase in depressive symptoms during 6 to 7 years of observation before the diagnosis (0.04 symptoms per year) and no change during 2 to 3 years of observation after the diagnosis except for a slight decrease in positive affect. In those with annual follow-up, neither AD nor its precursor, mild cognitive impairment, was associated with change in informant report of depressive symptoms during a mean of 3 years of observation. CONCLUSION: Depressive symptoms show little change during the development and progression of AD to a moderate level of dementia severity.

Cognitive decline in incident Alzheimer disease in a community population.

OBJECTIVE: To measure the cognitive consequences of incident Alzheimer disease (AD) in older African American and white subjects. METHODS: Data are from the Chicago Health and Aging Project, a longitudinal cohort study of older white and black persons residing in a geographically defined community. At 3-year intervals, the entire study population completed 4 brief cognitive tests, from which a previously established composite measure of global cognition was derived, and a subset underwent detailed clinical evaluation that supported clinical classification of mild cognitive impairment, dementia, and AD. We used mixed-effects models to examine change in cognitive function following the diagnostic evaluation. RESULTS: On clinical evaluation, 614 persons were found to have no cognitive impairment, 395 had mild cognitive impairment, and 149 had AD (88.5% mild); 10 persons with other dementias were excluded from analyses. During up to 11 years of observation following the clinical evaluation (mean = 5.5, SD = 2.5), the composite measure of global cognition declined a mean of 0.042 unit per year (SE = 0.008, p < 0.001) in those with no cognitive impairment. In comparison to the no cognitive impairment group, the annual rate of decline was increased more than twofold in mild cognitive impairment (estimate = 0.086, SE = 0.011, p < 0.001) and more than fourfold in AD (estimate = 0.173, SE = 0.020, p < 0.001). Results did not reliably vary by race, sex, or age. CONCLUSIONS: Alzheimer disease has a devastating impact on cognition, even in its prodromal stages, with comparable effects in African American and white persons.

Educational attainment and cognitive decline in old age.

BACKGROUND: Level of education is a well-established risk factor for Alzheimer disease but its relation to cognitive decline, the principal clinical manifestation of the disease, is uncertain. METHODS: More than 6,000 older residents of a community on the south side of Chicago were interviewed at approximately 3-year intervals for up to 14 years. The interview included administration of four brief tests of cognitive function from which a previously established composite measure of global cognition was derived. We estimated the associations of education with baseline level of cognition and rate of cognitive change in a series of mixed-effects models. RESULTS: In an initial analysis, higher level of education was related to higher level of cognition at baseline, but there was no linear association between education and rate of change in cognitive function. In a subsequent analysis with terms to allow for nonlinearity in education and its relation to cognitive decline, rate of cognitive decline at average or high levels of education was slightly increased during earlier years of follow-up but slightly decreased in later years in comparison to low levels of education. Findings were similar among black and white participants. Cognitive performance improved with repeated test administration, but there was no evidence that retest effects were related to education or attenuated education's association with cognitive change. CONCLUSIONS: The results suggest that education is robustly associated with level of cognitive function but not with rate of cognitive decline and that the former association primarily accounts for education's correlation with risk of dementia in old age.

Diamond-metal contacts: interface barriers and real-time characterization.

A review of diamond-metal contacts is presented with reference to reported values of interfacial potential (Schottky) barriers and their dependence on macroscopic and microscopic properties of the diamond surface, the interface and the metal. No simple model can account for the overall spread of p-diamond barriers, although there are, for certain metals, correlations with metal electronegativity, interface chemistry and diamond surface preparation. Detailed studies are presented for a selected contact (Al-p-diamond) using real-time monitoring during metal growth from sub-nanometre to bulk films and subsequent in situ heating to 1000 °C. This contact, prepared in a clean vacuum environment on characterized single-crystal substrates, provides a case study for a combined in situ electrical and spectroscopic investigation using IV measurements for macroscopic diodes and real-time photoelectron spectroscopy for nanoscale metal films. Band bending during growth leads to a rectifying contact with a measured IV barrier height of 1.05 V and an ideality factor of 1.4. A transition from layered to clustered growth of the metal film is revealed in the real-time measurements and this is confirmed by AFM. For the annealed contact, a direct correlation is revealed by real-time photoemission between the onset of interfacial carbide formation and the change from a rectifying to an ohmic contact at 482 °C.

Relation of NSAIDs to incident AD, change in cognitive function, and AD pathology.

OBJECTIVE: To examine the relation of nonsteroidal anti-inflammatory drugs (NSAIDs) to incident Alzheimer disease (AD), change in cognition, and AD pathology. METHODS: Participants were 1,019 older Catholic clergy followed up annually for up to 12 years (mean baseline age = 75.0 years, education = 18.1 years, Mini-Mental State Examination score = 28.5), enrolled in the Religious Orders Study, a longitudinal clinical-pathologic study of aging and AD. Clinical evaluations allowed for AD classification and assessment of global cognition and five cognitive domains. NSAIDs were identified by direct medication inspection at baseline and follow-up evaluations. Neuropathologic data were available on 328 deceased participants. AD pathology was summarized as a global measure and as measures of neuritic plaques, diffuse plaques, and neurofibrillary tangles. We used Cox proportional hazards models and mixed models for incident AD and cognitive decline, respectively, and logistic and linear regression for pathologic outcomes, adjusted for age, sex, and education. RESULTS: Overall, we found no apparent relation of NSAIDs to incident AD (n = 209 cases), change in cognition, or AD pathology. The hazard ratio of incident AD was 1.19 (95% CI 0.87-1.62) comparing those using NSAIDs with those not using NSAIDs at baseline, and 0.84 (95% CI 0.63-1.11) for specific use of aspirin. Findings were similar in analyses in which we considered NSAID use during follow-up. NSAIDs were not related to change in cognition (all p values > 0.14). There was no relation of NSAIDs to global AD pathology or plaques or tangles. CONCLUSION: These data do not support a strong relation between nonsteroidal anti-inflammatory drugs and Alzheimer disease or cognition. Consistent findings across clinical and pathologic outcomes provide additional confidence in these results.