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Associations of centrally acting ACE inhibitors with cognitive decline and survival in Alzheimer's disease

  • Karim Fazal (a1), Gayan Perera (a2), Mizanur Khondoker (a3), Robert Howard (a4) and Robert Stewart (a2)...
Abstract
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.

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Copyright
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
Corresponding author
Correspondence: Gayan Perera, Department of Psychological Medicine (Box 92), Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK. Email: gayan.perera@kcl.ac.uk
Footnotes
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*

These authors contributed equally to this work.

Declaration of interest

R.S. has received research funding from Pfizer, Lundbeck, Roche, Janssen and GlaxoSmithKline.

Footnotes
References
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Associations of centrally acting ACE inhibitors with cognitive decline and survival in Alzheimer's disease

  • Karim Fazal (a1), Gayan Perera (a2), Mizanur Khondoker (a3), Robert Howard (a4) and Robert Stewart (a2)...
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