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

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dc.contributor.authorGao, Yang
dc.contributor.authorO'Caoimh, Rónán
dc.contributor.authorHealy, Liam
dc.contributor.authorKerins, David M.
dc.contributor.authorEustace, Joseph A.
dc.contributor.authorGuyatt, Gordon
dc.contributor.authorSammon, David
dc.contributor.authorMolloy, D. William
dc.contributor.funderAtlantic Philanthropiesen
dc.contributor.funderHealth Service Executive, Irelanden
dc.contributor.funderIrish Hospice Foundationen
dc.contributor.funderCanadian Institutes of Health Researchen
dc.date.accessioned2019-02-27T16:03:49Z
dc.date.available2019-02-27T16:03:49Z
dc.date.issued2013-07-22
dc.date.updated2019-02-27T15:54:09Z
dc.description.abstractObjectives: 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.en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationGao, 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-2013-002881en
dc.identifier.doi10.1136/bmjopen-2013-002881
dc.identifier.endpagee002881-8en
dc.identifier.issn2044-6055
dc.identifier.issued7en
dc.identifier.journaltitleBmj Openen
dc.identifier.startpagee002881-1en
dc.identifier.urihttps://hdl.handle.net/10468/7552
dc.identifier.volume3en
dc.language.isoenen
dc.publisherBMJ Publishing Groupen
dc.relation.urihttps://bmjopen.bmj.com/content/bmjopen/3/7/e002881.full.pdf
dc.rights© 2013 The Authors. Published by the BMJ Publishing Group Limited. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcodeen
dc.rights.urihttp://creativecommons.org/licenses/by-nc/3.0/en
dc.subjectDipeptidyl carboxypeptidase inhibitoren
dc.subjectAgeden
dc.subjectCognitive defecten
dc.subjectControlled studyen
dc.subjectDementiaen
dc.subjectHospital based case control studyen
dc.subjectMini Mental State Examinationen
dc.subjectObservational studyen
dc.subjectOutcome assessmenten
dc.subjectQuick Mild Cognitive Impairment scoreen
dc.subjectScoring systemen
dc.subjectUniversity hospitalen
dc.titleEffects of centrally acting ACE inhibitors on the rate of cognitive decline in dementiaen
dc.typeArticle (peer-reviewed)en
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