A new trial, one of many exploring the prevention and treatment of dementia, has shown a small but significant reduction in the rate of cognitive decline in patients taking centrally acting ACE inhibitors (CACE-Is), particularly if they are new.

817 patients with Alzheimer’s disease, vascular, or mixed dementia measured for Quick Mild Cognitive Impairment (Qmci) and Standardised Mini-Mental State Examination (SMMSE) at diagnosis and at six months showed the following results:

Score Changes at Six Months

Score points No CACEI CACEI New CACEI
Qmci – 2.1 – 1.8 *
SMMSE – 1.0 – 0.8 + 1.2

* Results not available.

Previous studies have shown mixed results, as ACE inhibitors may accelerate cognitive decline, dementia severity, and even mortality in some patients; and perindopril (with indapamide) has been shown to reduce the incidence of stroke and cognitive decline.

Clarity is emerging in that ACE-Is may increase amyloid burden, where CACE-Is cross the blood brain barrier to reduce inflammation contributing to Alzheimer’s disease (independent of hypertension). The authors suggest that some, but not all, patients may benefit from CACE-Is and it may become necessary to identify the underlying pathology of the cognitive impairment to guide therapy choices.

References:

  1. Gao Y, O’Caoimh R, Healy L, Kerins DM, Eustace J, Guyatt G, et al. Effects of centrally acting ACE inhibitors on the rate of cognitive decline in dementia. BMJ Open 2013; 3(7): e002881.
  2. Anderson P. ACE Inhibitors May Slow Cognitive Decline. Medscape Medical News 2013; Neurology: July 29.

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