Centrally acting ACE inhibitors reduce rate of cognitive decline in dementia patients

Antihypertensive medications, specifically centrally acting ACE inhibitors, may help improve cognitive scores in patients with dementia, according to a report in the BMJ Open.

The drugs were associated with a reduced rate of cognitive decline in patients diagnosed with Alzheimer’s disease, vascular, or mixed dementia, treated for 6 months in an observational case-control study at two university hospital memory clinics, reported Yang Gao, Department of Epidemiology, University of North Carolina at Chapel Hill, and colleagues.

More than 800 patients were included in the study: 537 with Alzheimer’s disease, 55 with vascular dementia, and 228 with both Alzheimer’s disease and vascular dementia. Of these individuals, 361 had baseline and end point Standardized Mini-Mental State Examination (SMMSE) scores or Quick Mild Cognitive Impairment (Qmci) scores and could be included in the analysis.

Before the 6-month study, 85 patients had received centrally acting ACE inhibitors and 276 had not. Of the patients not receiving the antihypertensive drugs, 30 were started on them.

“This study demonstrates a small reduction in the rate of cognitive decline, measured with the SMMSE and Qmci, in patients taking centrally acting ACE inhibitors compared to the NoCACE-I group. The changes in Qmci scores over 6 months were small but statistically significant. The SMMSE scores, while non-significant, suggested a possible slower progression among those currently receiving centrally acting ACE inhibitors,” Gao and colleagues noted.

Those new patients who started on centrally acting ACE inhibitors showed a median improvement instead of a decline in SMMSE scores over the 6-month period, compared to the scores of those already taking the drugs and those not taking them.

“This is the first study to demonstrate that cognitive scores improve in patients starting on centrally acting ACE inhibitors, compared to those already established on maintenance treatment. This may have been related to better medication compliance, the effects of improved BP control or increased cerebrovascular perfusion after initial treatment,” the authors wrote.