title: Effects of centrally acting ACE inhibitors on the rate of cognitive decline in dementia.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  Observational case-control study.
  
  
  METHODS
  2 university hospital memory clinics.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs' Hospital, Cork City, Ireland.
authors.forename: Yang
authors.initials: Y
authors.lastname: Gao
authors.forename: Rónán
authors.initials: R
authors.lastname: O'Caoimh
authors.forename: Liam
authors.initials: L
authors.lastname: Healy
authors.forename: David M
authors.initials: DM
authors.lastname: Kerins
authors.forename: Joseph
authors.initials: J
authors.lastname: Eustace
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
authors.forename: David
authors.initials: D
authors.lastname: Sammon
authors.forename: D William
authors.initials: DW
authors.lastname: Molloy
keywords: Geriatric Medicine