Effects of centrally acting ACE inhibitors on the rate of cognitive decline in dementia
Identifieur interne : 000664 ( Pmc/Checkpoint ); précédent : 000663; suivant : 000665Effects 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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PMC:3703568Le document en format XML
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<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>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMJ Open</journal-id>
<journal-id journal-id-type="iso-abbrev">BMJ Open</journal-id>
<journal-id journal-id-type="hwp">bmjopen</journal-id>
<journal-id journal-id-type="publisher-id">bmjopen</journal-id>
<journal-title-group><journal-title>BMJ Open</journal-title>
</journal-title-group>
<issn pub-type="epub">2044-6055</issn>
<publisher><publisher-name>BMJ Publishing Group</publisher-name>
<publisher-loc>BMA House, Tavistock Square, London, WC1H 9JR</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">23887090</article-id>
<article-id pub-id-type="pmc">3703568</article-id>
<article-id pub-id-type="publisher-id">bmjopen-2013-002881</article-id>
<article-id pub-id-type="doi">10.1136/bmjopen-2013-002881</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Geriatric Medicine</subject>
<subj-group><subject>Research</subject>
</subj-group>
</subj-group>
<subj-group subj-group-type="hwp-journal-coll"><subject>1506</subject>
<subject>1698</subject>
<subject>1683</subject>
<subject>1713</subject>
<subject>1723</subject>
</subj-group>
</article-categories>
<title-group><article-title>Effects of centrally acting ACE inhibitors on the rate of cognitive decline in dementia</article-title>
<alt-title alt-title-type="short">Centrally acting ACE inhibitors in dementia</alt-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Gao</surname>
<given-names>Yang</given-names>
</name>
<xref ref-type="aff" rid="af1">1</xref>
<xref ref-type="aff" rid="af2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>O'Caoimh</surname>
<given-names>Rónán</given-names>
</name>
<xref ref-type="aff" rid="af1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Healy</surname>
<given-names>Liam</given-names>
</name>
<xref ref-type="aff" rid="af1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kerins</surname>
<given-names>David M</given-names>
</name>
<xref ref-type="aff" rid="af3">3</xref>
<xref ref-type="aff" rid="af4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Eustace</surname>
<given-names>Joseph</given-names>
</name>
<xref ref-type="aff" rid="af5">5</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Guyatt</surname>
<given-names>Gordon</given-names>
</name>
<xref ref-type="aff" rid="af6">6</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sammon</surname>
<given-names>David</given-names>
</name>
<xref ref-type="aff" rid="af2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Molloy</surname>
<given-names>D William</given-names>
</name>
<xref ref-type="aff" rid="af1">1</xref>
<xref ref-type="aff" rid="af7">7</xref>
</contrib>
</contrib-group>
<aff id="af1"><label>1</label>
<institution>Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs’ Hospital</institution>
,<addr-line>Cork City</addr-line>
,<country>Ireland</country>
</aff>
<aff id="af2"><label>2</label>
<addr-line>Department of Business Information Systems</addr-line>
,<institution>University College Cork</institution>
,<addr-line>Cork</addr-line>
,<country>Ireland</country>
</aff>
<aff id="af3"><label>3</label>
<addr-line>Department of Pharmacology and Therapeutics</addr-line>
,<institution>University College Cork</institution>
,<addr-line>Cork</addr-line>
,<country>Ireland</country>
</aff>
<aff id="af4"><label>4</label>
<institution>Mercy University Hospital</institution>
,<addr-line>Cork</addr-line>
,<country>Ireland</country>
</aff>
<aff id="af5"><label>5</label>
<addr-line>Clinical Research Facility</addr-line>
,<institution>Mercy University Hospital</institution>
,<addr-line>Cork</addr-line>
,<country>Ireland</country>
</aff>
<aff id="af6"><label>6</label>
<addr-line>Department of Clinical Epidemiology & Biostatistics</addr-line>
,<institution>McMaster University</institution>
,<addr-line>Hamilton, Ontario</addr-line>
,<country>Canada</country>
</aff>
<aff id="af7"><label>7</label>
<addr-line>Department of Medicine</addr-line>
,<institution>McMaster University</institution>
,<addr-line>Hamilton, Ontario</addr-line>
,<country>Canada</country>
</aff>
<author-notes><corresp><label>Correspondence to</label>
Professor D William Molloy; <email>w.molloy@ucc.ie</email>
</corresp>
</author-notes>
<pub-date pub-type="collection"><year>2013</year>
</pub-date>
<pub-date pub-type="epub"><day>2</day>
<month>7</month>
<year>2013</year>
</pub-date>
<volume>3</volume>
<issue>7</issue>
<elocation-id>e002881</elocation-id>
<history><date date-type="received"><day>14</day>
<month>3</month>
<year>2013</year>
</date>
<date date-type="rev-recd"><day>9</day>
<month>5</month>
<year>2013</year>
</date>
<date date-type="accepted"><day>14</day>
<month>5</month>
<year>2013</year>
</date>
</history>
<permissions><copyright-statement>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</copyright-statement>
<copyright-year>2013</copyright-year>
<license license-type="open-access"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>
and <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/legalcode">http://creativecommons.org/licenses/by-nc/3.0/legalcode</ext-link>
</license-p>
</license>
</permissions>
<self-uri xlink:title="pdf" xlink:type="simple" xlink:href="bmjopen-2013-002881.pdf"></self-uri>
<self-uri content-type="draft-revisions-pdf" xlink:type="simple" xlink:href="bmjopen-2013-002881.draft_revisions.pdf"></self-uri>
<self-uri content-type="reviewers-comments-pdf" xlink:type="simple" xlink:href="bmjopen-2013-002881.reviewer_comments.pdf"></self-uri>
<abstract><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>
</abstract>
<kwd-group><kwd>Geriatric Medicine</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
<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)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Canada/explor/ParkinsonCanadaV1/Data/Pmc/Checkpoint
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000664 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Checkpoint/biblio.hfd -nk 000664 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien |wiki= Wicri/Canada |area= ParkinsonCanadaV1 |flux= Pmc |étape= Checkpoint |type= RBID |clé= PMC:3703568 |texte= Effects of centrally acting ACE inhibitors on the rate of cognitive decline in dementia }}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Checkpoint/RBID.i -Sk "pubmed:23887090" \ | HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Checkpoint/biblio.hfd \ | NlmPubMed2Wicri -a ParkinsonCanadaV1
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