Centrally Acting ACE Inhibitors Might Slow Cognitive Decline in Patients with Dementia

Use of diuretics, calcium-channel blockers (CCBs), angiotensin-receptor blockers, or angiotensin-converting–enzyme (ACE) inhibitors is associated with less risk for dementia. Evidence suggests that centrally acting ACE inhibitors (i.e., ramipril, trandolapril, captopril, fosinopril, and lisinopril), which cross the blood-brain barrier, are more protective than non–centrally acting ACE inhibitors or CCBs. In this case-control study, investigators compared the rates of cognitive decline among 361 Canadian patients (mean age, 78) with dementia; 85 patients were receiving centrally acting ACE inhibitors at the start of the study.

Standardized Mini-Mental State Examination (SMMSE) and Quick Mild Cognitive Impairment (Qmci) scores were recorded at ≥2 visits for each patient. At 6 months, Qmci scores declined slightly less in patients who took centrally acting ACE inhibitors than in those who did not (P=0.049); similar, but nonsignificant, results were obtained for SMMSE scores. SMMSE data also were available for 30 patients who initially were not receiving centrally acting ACE inhibitors but who started taking the drugs. The median SMMSE score increased 1.2 points (on a 30-point scale) in the first 6 months of treatment compared with 0.8-point and 1.0-point declines for patients who already were taking centrally acting ACE inhibitors and for those who weren't taking any ACE inhibitors during the same period; these differences were significant.