Effects of centrally acting ACE inhibitors on the rate of cognitive decline in dementia

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Gao, Yang
O'Caoimh, Rónán
Healy, Liam
Kerins, David M.
Eustace, Joseph A.
Guyatt, Gordon
Sammon, David
Molloy, D. William
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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.
Dipeptidyl carboxypeptidase inhibitor , Aged , Cognitive defect , Controlled study , Dementia , Hospital based case control study , Mini Mental State Examination , Observational study , Outcome assessment , Quick Mild Cognitive Impairment score , Scoring system , University hospital
Gao, Y., O'Caoimh, R., Healy, L., Kerins, D. M., Eustace, J., Guyatt, G., Sammon, D. and Molloy, D. W. (2013) 'Effects of centrally acting ACE inhibitors on the rate of cognitive decline in dementia', BMJ Open, 3(7), e002881 (8 pp). doi: 10.1136/bmjopen-2013-002881