A genetic analysis of more than 13,500 older adults found that low-dose aspirin was linked to fewer dementia cases in people with a particular genetic profile, but also to more serious bleeding.

Monash University researchers examined participants in the Aspirin in Reducing Events in the Elderly trial, known as ASPREE. They used genetic scores linked to platelet counts to examine differences in how participants responded to aspirin. Among people in the highest 20% of those scores, about 1% taking aspirin developed dementia, compared with 3.3% receiving a placebo. That represents roughly a 70% relative reduction, or a 2.3 percentage-point difference. Major bleeding affected 4.4% of aspirin recipients in the same subgroup, compared with 2.1% taking the placebo.

Earlier analyses found no overall benefit of aspirin for dementia prevention. Researchers said this genetic finding needs confirmation in other studies and a trial specifically designed for the subgroup. They cautioned against starting aspirin for dementia prevention without consulting a physician. The study’s findings did not establish an alternative treatment recommendation for older adults.

A cheap medicine that delayed dementia would have considerable value for patients, families, and health systems. Aspirin’s widespread availability makes the finding attractive, but its familiarity can also make its risks easier to underestimate. A drug sold without a prescription can still cause serious harm…

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The numbers show the difficulty. In this subgroup, aspirin was associated with roughly 23 fewer dementia cases per 1,000 participants, alongside approximately 23 additional major bleeding events. Those outcomes are not interchangeable. Their severity, timing, and consequences would matter in judging any preventive benefit.

The genetic approach does offer a possible explanation for results that disappear when an entire population is considered together. Such treatment might help a more narrowly defined group without benefiting the lion’s share of people who take it. Still, identifying that group reliably would be imperative before translating any analysis into a prescribing decision.

Subgroup findings also arise by chance, particularly when researchers examine multiple possible differences. Therefore, confirmation requires more than repeating the headline result.

A targeted trial must establish that genetic selection predicts a dependable benefit and that the benefit outweighs the bleeding risk for those patients.

Dementia is a common worry for many older Americans and their families. While an inexpensive pill is appealing, especially when the alternative is years of uncertainty and likely costly care, this research does not yet identify who can safely take aspirin for that purpose.

The genetic score used in the analysis is not a treatment recommendation, nor does the finding provide a reason to change aspirin prescribed for another condition without discussing it with a doctor. But the encouraging possibility is that prevention could become more selective. Rather than asking millions of older adults to accept the same risk, researchers may eventually identify people whose biology makes treatment worthwhile.