Key result
Exposure to centrally acting ACE inhibitors was associated with a significant initial improvement in cognitive function by 0.72 MMSE points per year over the first 9 months compared to a decline of 0.61 points per year with non-centrally acting ACE inhibitors.
Why the study?
Do centrally acting ACE inhibitors improve cognitive decline and survival in patients with Alzheimer's disease receiving acetylcholinesterase inhibitors?
Cohort (n=5,260)
Do centrally acting ACE inhibitors improve cognitive decline and survival in patients with Alzheimer's disease receiving acetylcholinesterase inhibitors?
Centrally acting ACE inhibitors are associated with a stronger initial improvement in cognitive function in Alzheimer's disease patients on acetylcholinesterase inhibitors, but do not alter long-term dementia progression or survival.
Should not yet guide ACE inhibitor selection for cognition; leaves open confirmation in randomized trials.
BACKGROUND: Cognitive improvement has been reported in patients receiving centrally acting angiotensin-converting enzyme inhibitors (C-ACEIs). AIMS: To compare cognitive decline and survival after diagnosis of Alzheimer's disease between people receiving C-ACEIs, non-centrally acting angiotensin-converting enzyme inhibitors (NC-ACEIs), and neither. METHOD: Routine Mini-Mental State Examination (MMSE) scores were extracted in 5260 patients receiving acetylcholinesterase inhibitors and analysed against C-/NC-ACEI exposure at the time of Alzheimer's disease diagnosis. RESULTS: In the 9 months after Alzheimer's disease diagnosis, MMSE scores significantly increased by 0.72 and 0.19 points per year in patients on C-ACEIs and neither respectively, but deteriorated by 0.61 points per year in those on NC-ACEIs. There were no significant group differences in score trajectories from 9 to 36 months and no differences in survival. CONCLUSIONS: In people with Alzheimer's disease receiving acetylcholinesterase inhibitors, those also taking C-ACEIs had stronger initial improvement in cognitive function, but there was no evidence of longer-lasting influence on dementia progression. DECLARATION OF INTEREST: R.
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Fazal et al. (2017) conducted a cohort in Alzheimer's disease (n=5,260). Centrally acting angiotensin-converting enzyme inhibitors (C-ACEIs) vs. Non-centrally acting ACE inhibitors (NC-ACEIs) was evaluated on Change in Mini-Mental State Examination (MMSE) score over the first 9 months after diagnosis (points per year) (MD 1.33, 95% CI 0.25-1.41, p=0.028). Exposure to centrally acting ACE inhibitors was associated with a significant initial improvement in cognitive function by 0.72 MMSE points per year over the first 9 months compared to a decline of 0.61 points per year with non-centrally acting ACE inhibitors.
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