Effects of centrally acting ACE inhibitors on the rate of cognitive decline in dementia
Identifieur interne : 000926 ( Pmc/Curation ); précédent : 000925; suivant : 000927Effects 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
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Effects of centrally acting ACE inhibitors on the rate of cognitive decline in dementia</title><author><name sortKey="Gao, Yang" sort="Gao, Yang" uniqKey="Gao Y" first="Yang" last="Gao">Yang Gao</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="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="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></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23887090</idno><idno type="pmc">3703568</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3703568</idno><idno type="RBID">PMC:3703568</idno><idno type="doi">10.1136/bmjopen-2013-002881</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">000926</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000926</idno><idno type="wicri:Area/Pmc/Curation">000926</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000926</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Effects of centrally acting ACE inhibitors on the rate of cognitive decline in dementia</title><author><name sortKey="Gao, Yang" sort="Gao, Yang" uniqKey="Gao Y" first="Yang" last="Gao">Yang Gao</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="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="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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<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></record>Pour manipuler ce document sous Unix (Dilib)
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