Background: Dementia is a slow progressing neurodegenerative disease characterized by loss of executive functioning, communication ability, and activities of daily living. With few treatment options currently approved for dementia, angiotensin-converting enzyme inhibitors (ACE-I) have been implicated as a new potential treatment to slow cognitive decline. ACE-I use in dementia, however, is controversial due to conflicting research and new discoveries into the pathophysiology of the brain and ACE. This systematic review aims to evaluate the current research on ACE-I use in cognitive decline.
Methods: Exhaustive search of available medical literature databases including Medline (Ovid/PubMed), Google Scholar, Clinical Key, and Web of Science was conducted. Keywords used in the search included: Alzheimer’s disease, dementia, ACE inhibitors, angiotensin converting enzyme inhibitors, cognitive decline, renin-angiotensin system, and RAS. Alzheimer’s disease (AD) and vascular dementia (VaD) was the focus of this review based on the proposed pathophysiology. Studies were included if cognitive assessment tools such as the mini mental status exam, mini-cog or Qmci, were assessed at baseline and an end-point with a minimum of 6 months. Articles were assessed for quality using the GRADE criteria.
Results: Five studies met inclusion criteria and were evaluated. Three of the studies found were observational, one study was a randomized controlled trial, and one was a cohort study. With the exception of one very low quality study, the results were consistent that ACE-I may provide slowing of the progression of cognitive decline in dementia patients.
Conclusion: Current research on dementia progression and ACE inhibitors, as measured by cognitive assessment tools, have been shown to slow cognitive decline in elderly patients. Further research, preferably multiple, large randomized controlled human trials are necessary to determine the risk versus benefit of ACE inhibitor use.
Keywords: Alzheimer’s disease, dementia, ACE inhibitors, angiotensin converting enzyme inhibitors, cognitive decline, renin-angiotensin system, RAS.
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