July 29, 2013
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ACE inhibitors slowed cognitive decline in patients with dementia

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Researchers have reported an association between the use of centrally acting ACE inhibitors and slower rates of cognitive decline in patients with dementia.

“[The findings] support the growing body of evidence for the use of ACE inhibitors and other antihypertensive agents in the management of dementia,” researchers wrote.

The observational, case-control, multicenter study included 361 patients with vascular or mixed dementia, Alzheimer’s disease, or both. Eighty-five patients were assigned centrally acting ACE inhibitors, 30 of whom initiated treatment within the previous 6 months. In the group assigned ACE inhibitors, the mean age was 77.2 years (51.8% men); in the group not assigned medication (n=276), the mean age was 77 years (49.6% men).

Researchers analyzed cognitive decline in each patient from 1999 to 2010 using the Standardized Mini Mental State Examination or the Quick Mild Cognitive Impairment test at baseline and at 6-month follow-up. ACE inhibitor users experienced marginally lower rates of cognitive decline compared with patients who did not use ACE inhibitors. The median 6-month rate of decline in the Quick Mild Cognitive Impairment test was significantly different in the ACE inhibitor (1.8 points) and non-ACE inhibitor groups (2.1 points; P=.049). Median Standardized Mini Mental State Examination scores improved by 1.2 points for new ACE inhibitor users during the first 6 months of treatment vs. an overall 0.8-point decline for the patients already using ACE inhibitors (P=.003) and a 1-point decline for patients who did not use ACE inhibitors (P=.001). These results indicate that patients who recently started treatment with ACE inhibitors had improved cognitive capacity compared with those with an established treatment regimen; however, this may be due to stricter medication adherence at the onset of treatment, the researchers said.

“Although the differences were small and of uncertain clinical significance, if sustained over years, the compounding effects may well have significant clinical benefits,” the researchers wrote.

However, they also noted that recent studies have linked ACE inhibitors to an increased amyloid burden and, thus, worsening rates of cognitive decline in patients with dementia.

“Further study with an appropriately powered randomized trial is needed to confirm these findings and determine if and for how long these effects are sustained,” the researchers said.

Disclosure: The researchers report no relevant financial disclosures.