Effects of centrally acting ACE inhibitors on the rate of cognitive decline in dementia
- Yang Gao1,2,
- Rónán O'Caoimh1,
- Liam Healy1,
- David M Kerins3,4,
- Joseph Eustace5,
- Gordon Guyatt6,
- David Sammon2,
- D William Molloy1,7
- 1Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs’ Hospital, Cork City, Ireland
- 2Department of Business Information Systems, University College Cork, Cork, Ireland
- 3Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland
- 4Mercy University Hospital, Cork, Ireland
- 5Clinical Research Facility, Mercy University Hospital, Cork, Ireland
- 6Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
- 7Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Correspondence to Professor D William Molloy;
- Received 14 March 2013
- Revised 9 May 2013
- Accepted 14 May 2013
- Published 22 July 2013
Objectives There is growing evidence that antihypertensive agents, particularly centrally acting ACE inhibitors (CACE-Is), which cross the blood–brain barrier, are associated with a reduced rate of cognitive decline. Given this, we compared the rates of cognitive decline in clinic patients with dementia receiving CACE-Is (CACE-I) with those not currently treated with CACE-Is (NoCACE-I), and with those who started CACE-Is, during their first 6 months of treatment (NewCACE-I).
Design Observational case–control study.
Setting 2 university hospital memory clinics.
Participants 817 patients diagnosed with Alzheimer's disease, vascular or mixed dementia. Of these, 361 with valid cognitive scores were included for analysis, 85 CACE-I and 276 NoCACE-I.
Measurements Patients were included if the baseline and end-point (standardised at 6 months apart) Standardised Mini-Mental State Examination (SMMSE) or Quick Mild Cognitive Impairment (Qmci) scores were available. Patients with comorbid depression or other dementia subtypes were excluded. The average 6-month rates of change in scores were compared between CACE-I, NoCACE-I and NewCACE-I patients.
Results When the rate of decline was compared between groups, there was a significant difference in the median, 6-month rate of decline in Qmci scores between CACE-I (1.8 points) and NoCACE-I (2.1 points) patients (p=0.049), with similar, non-significant changes in SMMSE. Median SMMSE scores improved by 1.2 points in the first 6 months of CACE treatment (NewCACE-I), compared to a 0.8 point decline for the CACE-I (p=0.003) group and a 1 point decline for the NoCACE-I (p=0.001) group over the same period. Multivariate analysis, controlling for baseline characteristics, showed significant differences in the rates of decline, in SMMSE, between the three groups, p=0.002.
Conclusions Cognitive scores may improve in the first 6 months after CACE-I treatment and use of CACE-Is is associated with a reduced rate of cognitive decline in patients with dementia.
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