Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork, Ireland.
Department of Clinical Epidemiology & Biostatistics, McMaster University, ON, Canada.
J Alzheimers Dis. 2014;40(3):595-603. doi: 10.3233/JAD-131694.
Centrally acting angiotensin converting enzyme inhibitors (CACE-Is) are associated with reduced rates of cognitive decline in patients with dementia. CACE-Is may also improve exercise tolerance in functionally impaired older adults with normal cognition, suggesting that CACE-Is may positively influence activities of daily living (ADL) in dementia.
To compare rates of decline in patients with mild to moderate Alzheimer's disease (AD) receiving CACE-Is to those not currently treated with CACE-Is (NoCACE-I), included in the Doxycycline and Rifampicin for Alzheimer's Disease study (n = 406).
Patients were included if baseline and end-point (twelve months apart) scores were available for measures including the Standardized Alzheimer's Disease Assessment Scale - Cognitive Subscale; Quick Mild Cognitive Impairment screen; Clinical Dementia Rating Scale (CDR-SB), and Lawton-Brody ADL Scale.
There was a significant, 25% difference (median one-point) in the 12-month rate of decline in ADL scores in patients taking CACE-Is (n = 91), compared to the NoCACE-I group (n = 274), p = 0.024. This remained significant after adjusting for age, gender, education, and blood pressure, p = 0.034. When individual CACE-Is were compared to the NoCACE-I group, a significant reduction in the rate of decline in ADLs (median one versus four points), were only observed for perindopril, p = 0.01. The CDR-SB was also reduced (median one-point) for the perindopril compared to the NoCACE-I group, p = 0.04.
This observational study suggests that CACE-Is, and potentially perindopril in particular, are associated with a reduced rate of functional decline in patients with AD, without an association with mood or behavior. This suggests that CACE-Is may slow disease progression in AD.
中枢作用血管紧张素转换酶抑制剂（CACE-Is）与痴呆患者认知能力下降速度降低有关。CACE-Is 还可能改善认知功能正常但功能受损的老年患者的运动耐量，这表明 CACE-Is 可能对痴呆患者的日常生活活动（ADL）产生积极影响。
比较轻度至中度阿尔茨海默病（AD）患者接受 CACE-Is 治疗与未接受 CACE-Is 治疗（NoCACE-I）的患者的下降速度，这些患者包括在多西环素和利福平治疗阿尔茨海默病研究中（n = 406）。
如果基线和终点（相隔 12 个月）的评分可用于包括标准化阿尔茨海默病评估量表 - 认知分量表；快速轻度认知障碍筛查；临床痴呆评定量表（CDR-SB）和 Lawton-Brody ADL 量表在内的测量指标，则患者可被纳入研究。
与 NoCACE-I 组（n = 274）相比，服用 CACE-Is（n = 91）的患者在 12 个月时 ADL 评分下降的速度有显著差异（中位数为 1 分），p = 0.024。调整年龄、性别、教育程度和血压后，这一结果仍然具有统计学意义，p = 0.034。当将各个 CACE-Is 与 NoCACE-I 组进行比较时，仅在培哚普利组观察到 ADL 下降速度（中位数为 1 分比 4 分）显著降低，p = 0.01。与 NoCACE-I 组相比，培哚普利组的 CDR-SB 也有所降低（中位数为 1 分），p = 0.04。
这项观察性研究表明，CACE-Is，特别是培哚普利，与 AD 患者功能下降速度减慢有关，而与情绪或行为无关。这表明 CACE-Is 可能减缓 AD 的疾病进展。
