title: Angiotensin-converting enzyme inhibitors and Alzheimer's disease progression in older adults: results from the Réseau sur la Maladie d'Alzheimer Français cohort.
abstract: OBJECTIVE
  To assess whether angiotensin-converting enzyme inhibitor (ACE-I) treatment is associated with less cognitive decline in older adults with Alzheimer's disease (AD) than in those using other hypertensive or no drugs.
  
  
  METHODS
  Four-year prospective multicenter cohort study with a biannual assessment.
  
  
  METHODS
  Memory clinics from 16 university hospitals in France.
  
  
  METHODS
  Community-dwelling older adults with mild to moderate AD (N = 616).
  
  
  METHODS
  Participants were stratified into four groups according to type and duration of antihypertensive drug treatment. Cognitive decline was assessed using the Mini-Mental State Examination (MMSE). Linear mixed-effects models were used to assess differences in decline in MMSE score between the four groups. Hypertension at each visit was included in the model.
  
  
  RESULTS
  Sixty-one participants had used ACE-Is continuously, 57 had used them intermittently, 189 had used other antihypertensive drugs, and 309 never used any antihypertensive drugs. Continuous ACE-Is users had a 4-year decline in MMSE of 6.4 ± 1.6 points (P < .001), intermittent ACE-Is users of 7.9 ± 1.1 points (P < .001), continuous or intermittent users of other antihypertensive drugs of 8.8 ± 0.7 points (P < .001), and never-users of 10.2 ± 0.6 points (P < .001). MMSE decline between the four groups was significantly different (adjusted P = .02). In subgroup analysis, the 118 (19.2%) participants who had continuously or intermittently used ACE-Is had a significant difference in 4-year MMSE decline from the 498 (80.8%) who had never used ACE-Is (7.5 ± 0.9 vs 9.7 ± 0.4; P = .03).
  
  
  CONCLUSIONS
  The use of ACE-Is in older adults with AD is associated with a slower rate of cognitive decline independent of hypertension. Future research is needed to explore the role of ACE-Is in long-term AD progression.
authors.affiliation: Department of Geriatric Medicine, Gérontopôle, CHU Toulouse University Hospital, Toulouse, France; Inserm, UMR1027, Toulouse, France.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Soto
authors.forename: Gabor Abellan
authors.initials: GA
authors.lastname: van Kan
authors.forename: Fati
authors.initials: F
authors.lastname: Nourhashemi
authors.forename: Sophie
authors.initials: S
authors.lastname: Gillette-Guyonnet
authors.forename: Matteo
authors.initials: M
authors.lastname: Cesari
authors.forename: Christelle
authors.initials: C
authors.lastname: Cantet
authors.forename: Yves
authors.initials: Y
authors.lastname: Rolland
authors.forename: Bruno
authors.initials: B
authors.lastname: Vellas
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003071:Cognition / Q000187:drug effects; D060825:Cognitive Dysfunction / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D009483:Neuropsychological Tests; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: Alzheimer's disease; angiotensin-converting enzyme-inhibitors; older adults