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ACE Inhibitors and Dementia

Posted Aug 04 2009 7:18pm
From Geriatric Pharmacy Intern Yesenia Martinez, PharmD(c)
Nova Southeastern University College of Pharmacy

It is estimated that by the year 2050 about 13 million adults may have dementia and that every 70 seconds someone in the U.S. is diagnosed with dementia. Dementia is a comprehensive term that encompasses conditions of the brain that cause a decline of brain function, and Alzheimer’s Disease and stroke are among the most common reasons for developing dementia. However, a new study has shown evidence that a certain class of medications known as angiotensin-converting enzyme (ACE) inhibitors, specifically the centrally-acting ones, may delay the onset of dementia.
Despite the fact that high blood pressure, or hypertension, alone is a major risk factor for Alzheimer’s Disease and vascular dementia and contributes greatly to the development of all types of dementia, it has now been shown that certain medications may also provide an added benefit in the brain for delaying the onset of dementia. This new study showed that patients exposed to the ACE inhibitors that cross the blood-brain barrier had an average of 65% less decline in cognitive function per year when compared to patients taking other blood pressure medications. The blood-brain barrier is a network of blood vessels designed to protect the brain from substances in the blood that would be harmful to it, and it is thought that these medications delay dementia by decreasing inflammation in the brain. The research also showed that patients who took the non-centrally acting ACE inhibitors had a 73% greater chance of developing dementia when compared to patients taking other blood pressure medications. Centrally acting ACE inhibitors include:
1) Captopril (Capoten)
2) Fosinopril (Monopril)
3) Lisinopril (Prinivil or Zestril)
4) Perindopril (Aceon)
5) Ramipril (Altace)
6) Trandolapril (Mavik)
The study involved 5,888 people over 65 years old from three different counties and one city, and specifically looked at 1,074 people who were being treated for high blood pressure and did not have dementia upon enrolling in the study. The investigators looked at whether taking ACE inhibitors had any effect on the development of dementia and loss of cognitive function, and whether there was any difference between the ACE inhibitors that cross the blood-brain barrier and those that do not. The diagnostic tool used was the Modified Mental State Exam (MMSE) which tests for cognitive functions, such as memory, language, and abstract reasoning. More detailed information can be found in the current issue of Archives of Internal Medicine.
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