Effects of centrally acting ACE inhibitors on the rate of cognitive decline in dementia
Identifieur interne : 000D88 ( Main/Exploration ); précédent : 000D87; suivant : 000D89Effects of centrally acting ACE inhibitors on the rate of cognitive decline in dementia
Auteurs : Yang Gao [Irlande (pays)] ; R Nán O'Caoimh [Irlande (pays)] ; Liam Healy [Irlande (pays)] ; David M. Kerins [Irlande (pays)] ; Joseph Eustace [Irlande (pays)] ; Gordon Guyatt [Canada] ; David Sammon [Irlande (pays)] ; D William Molloy [Irlande (pays), Canada]Source :
- BMJ Open [ 2044-6055 ] ; 2013.
Abstract
There is growing evidence that antihypertensive agents, particularly centrally acting ACE inhibitors (CACE-Is), which cross the blood–brain barrier, are associated with a reduced rate of cognitive decline. Given this, we compared the rates of cognitive decline in clinic patients with dementia receiving CACE-Is (CACE-I) with those not currently treated with CACE-Is (NoCACE-I), and with those who started CACE-Is, during their first 6 months of treatment (NewCACE-I).
Observational case–control study.
2 university hospital memory clinics.
817 patients diagnosed with Alzheimer's disease, vascular or mixed dementia. Of these, 361 with valid cognitive scores were included for analysis, 85 CACE-I and 276 NoCACE-I.
Patients were included if the baseline and end-point (standardised at 6 months apart) Standardised Mini-Mental State Examination (SMMSE) or Quick Mild Cognitive Impairment (Qmci) scores were available. Patients with comorbid depression or other dementia subtypes were excluded. The average 6-month rates of change in scores were compared between CACE-I, NoCACE-I and NewCACE-I patients.
When the rate of decline was compared between groups, there was a significant difference in the median, 6-month rate of decline in Qmci scores between CACE-I (1.8 points) and NoCACE-I (2.1 points) patients (p=0.049), with similar, non-significant changes in SMMSE. Median SMMSE scores improved by 1.2 points in the first 6 months of CACE treatment (NewCACE-I), compared to a 0.8 point decline for the CACE-I (p=0.003) group and a 1 point decline for the NoCACE-I (p=0.001) group over the same period. Multivariate analysis, controlling for baseline characteristics, showed significant differences in the rates of decline, in SMMSE, between the three groups, p=0.002.
Cognitive scores may improve in the first 6 months after CACE-I treatment and use of CACE-Is is associated with a reduced rate of cognitive decline in patients with dementia.
Url:
DOI: 10.1136/bmjopen-2013-002881
PubMed: 23887090
PubMed Central: 3703568
Affiliations:
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Cork</institution>,<addr-line>Cork</addr-line>,<country>Ireland</country></nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Molloy, D William" sort="Molloy, D William" uniqKey="Molloy D" first="D William" last="Molloy">D William Molloy</name><affiliation wicri:level="1"><nlm:aff id="af1"><institution>Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs’ Hospital</institution>,<addr-line>Cork City</addr-line>,<country>Ireland</country></nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af7"><addr-line>Department of Medicine</addr-line>,<institution>McMaster University</institution>,<addr-line>Hamilton, Ontario</addr-line>,<country>Canada</country></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea># see 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Cork</institution>,<addr-line>Cork</addr-line>,<country>Ireland</country></nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="O Caoimh, R Nan" sort="O Caoimh, R Nan" uniqKey="O Caoimh R" first="R Nán" last="O'Caoimh">R Nán O'Caoimh</name><affiliation wicri:level="1"><nlm:aff id="af1"><institution>Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs’ Hospital</institution>,<addr-line>Cork City</addr-line>,<country>Ireland</country></nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Healy, Liam" sort="Healy, Liam" uniqKey="Healy L" first="Liam" last="Healy">Liam Healy</name><affiliation wicri:level="1"><nlm:aff id="af1"><institution>Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs’ Hospital</institution>,<addr-line>Cork City</addr-line>,<country>Ireland</country></nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Kerins, David M" sort="Kerins, David M" uniqKey="Kerins D" first="David M" last="Kerins">David M. Kerins</name><affiliation wicri:level="1"><nlm:aff id="af3"><addr-line>Department of Pharmacology and Therapeutics</addr-line>,<institution>University College Cork</institution>,<addr-line>Cork</addr-line>,<country>Ireland</country></nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af4"><institution>Mercy University Hospital</institution>,<addr-line>Cork</addr-line>,<country>Ireland</country></nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Eustace, Joseph" sort="Eustace, Joseph" uniqKey="Eustace J" first="Joseph" last="Eustace">Joseph Eustace</name><affiliation wicri:level="1"><nlm:aff id="af5"><addr-line>Clinical Research Facility</addr-line>,<institution>Mercy University Hospital</institution>,<addr-line>Cork</addr-line>,<country>Ireland</country></nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Guyatt, Gordon" sort="Guyatt, Gordon" uniqKey="Guyatt G" first="Gordon" last="Guyatt">Gordon Guyatt</name><affiliation wicri:level="1"><nlm:aff id="af6"><addr-line>Department of Clinical Epidemiology & Biostatistics</addr-line>,<institution>McMaster University</institution>,<addr-line>Hamilton, Ontario</addr-line>,<country>Canada</country></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Sammon, David" sort="Sammon, David" uniqKey="Sammon D" first="David" last="Sammon">David Sammon</name><affiliation wicri:level="1"><nlm:aff id="af2"><addr-line>Department of Business Information Systems</addr-line>,<institution>University College Cork</institution>,<addr-line>Cork</addr-line>,<country>Ireland</country></nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Molloy, D William" sort="Molloy, D William" uniqKey="Molloy D" first="D William" last="Molloy">D William Molloy</name><affiliation wicri:level="1"><nlm:aff id="af1"><institution>Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs’ Hospital</institution>,<addr-line>Cork City</addr-line>,<country>Ireland</country></nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af7"><addr-line>Department of Medicine</addr-line>,<institution>McMaster University</institution>,<addr-line>Hamilton, Ontario</addr-line>,<country>Canada</country></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">BMJ Open</title><idno type="eISSN">2044-6055</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objectives</title><p>There is growing evidence that antihypertensive agents, particularly centrally acting ACE inhibitors (CACE-Is), which cross the blood–brain barrier, are associated with a reduced rate of cognitive decline. Given this, we compared the rates of cognitive decline in clinic patients with dementia receiving CACE-Is (CACE-I) with those not currently treated with CACE-Is (NoCACE-I), and with those who started CACE-Is, during their first 6 months of treatment (NewCACE-I).</p></sec><sec><title>Design</title><p>Observational case–control study.</p></sec><sec><title>Setting</title><p>2 university hospital memory clinics.</p></sec><sec><title>Participants</title><p>817 patients diagnosed with Alzheimer's disease, vascular or mixed dementia. Of these, 361 with valid cognitive scores were included for analysis, 85 CACE-I and 276 NoCACE-I.</p></sec><sec><title>Measurements</title><p>Patients were included if the baseline and end-point (standardised at 6 months apart) Standardised Mini-Mental State Examination (SMMSE) or Quick Mild Cognitive Impairment (Qmci) scores were available. Patients with comorbid depression or other dementia subtypes were excluded. The average 6-month rates of change in scores were compared between CACE-I, NoCACE-I and NewCACE-I patients.</p></sec><sec><title>Results</title><p>When the rate of decline was compared between groups, there was a significant difference in the median, 6-month rate of decline in Qmci scores between CACE-I (1.8 points) and NoCACE-I (2.1 points) patients (p=0.049), with similar, non-significant changes in SMMSE. Median SMMSE scores improved by 1.2 points in the first 6 months of CACE treatment (NewCACE-I), compared to a 0.8 point decline for the CACE-I (p=0.003) group and a 1 point decline for the NoCACE-I (p=0.001) group over the same period. Multivariate analysis, controlling for baseline characteristics, showed significant differences in the rates of decline, in SMMSE, between the three groups, p=0.002.</p></sec><sec><title>Conclusions</title><p>Cognitive scores may improve in the first 6 months after CACE-I treatment and use of CACE-Is is associated with a reduced rate of cognitive decline in patients with dementia.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Ferri, Cp" uniqKey="Ferri C">CP Ferri</name></author><author><name sortKey="Prince, M" uniqKey="Prince M">M Prince</name></author><author><name sortKey="Brayne, C" uniqKey="Brayne C">C Brayne</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sloane, Pd" uniqKey="Sloane P">PD Sloane</name></author><author><name sortKey="Zimmerman, S" uniqKey="Zimmerman S">S Zimmerman</name></author><author><name sortKey="Suchindran, C" uniqKey="Suchindran C">C 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Kamata</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kehoe, Pg" uniqKey="Kehoe P">PG Kehoe</name></author><author><name sortKey="Passmore, Pa" uniqKey="Passmore P">PA Passmore</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fournier, A" uniqKey="Fournier A">A Fournier</name></author><author><name sortKey="Oprisiu Fournier, R" uniqKey="Oprisiu Fournier R">R Oprisiu-Fournier</name></author><author><name sortKey="Serot, J M" uniqKey="Serot J">J-M Serot</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kehoe, Pg" uniqKey="Kehoe P">PG Kehoe</name></author><author><name sortKey="Davies, Nm" uniqKey="Davies N">NM Davies</name></author><author><name sortKey="Martin, Rm" uniqKey="Martin R">RM Martin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Todd, S" uniqKey="Todd S">S Todd</name></author><author><name sortKey="Mcguinness, B" uniqKey="Mcguinness B">B McGuinness</name></author><author><name sortKey="Passmore, Ap" uniqKey="Passmore A">AP Passmore</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Canada</li><li>Irlande (pays)</li></country></list><tree><country name="Irlande (pays)"><noRegion><name sortKey="Gao, Yang" sort="Gao, Yang" uniqKey="Gao Y" first="Yang" last="Gao">Yang Gao</name></noRegion><name sortKey="Eustace, Joseph" sort="Eustace, Joseph" uniqKey="Eustace J" first="Joseph" last="Eustace">Joseph Eustace</name><name sortKey="Gao, Yang" sort="Gao, Yang" uniqKey="Gao Y" first="Yang" last="Gao">Yang Gao</name><name sortKey="Healy, Liam" sort="Healy, Liam" uniqKey="Healy L" first="Liam" last="Healy">Liam Healy</name><name sortKey="Kerins, David M" sort="Kerins, David M" uniqKey="Kerins D" first="David M" last="Kerins">David M. Kerins</name><name sortKey="Kerins, David M" sort="Kerins, David M" uniqKey="Kerins D" first="David M" last="Kerins">David M. Kerins</name><name sortKey="Molloy, D William" sort="Molloy, D William" uniqKey="Molloy D" first="D William" last="Molloy">D William Molloy</name><name sortKey="O Caoimh, R Nan" sort="O Caoimh, R Nan" uniqKey="O Caoimh R" first="R Nán" last="O'Caoimh">R Nán O'Caoimh</name><name sortKey="Sammon, David" sort="Sammon, David" uniqKey="Sammon D" first="David" last="Sammon">David Sammon</name></country><country name="Canada"><noRegion><name sortKey="Guyatt, Gordon" sort="Guyatt, Gordon" uniqKey="Guyatt G" first="Gordon" last="Guyatt">Gordon Guyatt</name></noRegion><name sortKey="Molloy, D William" sort="Molloy, D William" uniqKey="Molloy D" first="D William" last="Molloy">D William Molloy</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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