Studies suggest that high dose NSAID use may be associated with a reversible impairment of cognition in the elderly. Prolonged NSAID use, on the other hand, may prevent the decline in cognition associated with aging. However, it has yet to be to be definitively determined whether this protection arises from an anti-inflammatory effect that modifies pathways involved in Alzheimer's dementia, or is mediated by a platelet effect that decreases the risk of cerebrovascular disease. Further large-scale, randomised, controlled trials using NSAIDs are needed before patients can be advised that the known risks of NSAIDs are outweighed by their potential long term benefits on cognition. While clinicians await the results of such studies, they should continue to be alert to the possibility of acute CNS adverse effects in their elderly patients who are receiving NSAIDs and to prescribe the minimum dose that is necessary to control pain and inflammation.