Angiotensin converting enzyme (ACE) inhibitors modulate the rate of progression of amnestic mild cognitive impairment.

BACKGROUND: Predictors of progression to dementia in individuals with mild cognitive impairment (MCI) define different groups with higher risks of progression. To date, efforts to differentiate those who will progress to dementia from those who will not have proved inconclusive, and while grades of risk have been identified, their generalizability is not clear.

AIM: To examine the clinical and socio-demographical risk factors for progression of memory decline in a sample of subjects with referred memory complaints who met criteria for amnestic MCI.

METHODS AND MATERIALS: Seventy-four subjects consecutively recruited who met the operational criteria for amnestic MCI. They underwent multidimensional assessment and a neuropsychological battery at baseline and at follow-up, after one year. Memory decline was defined using the short story mean score change (at follow-up and at baseline). Subjects showing memory decline, with or without conversion to AD over time, were classified as having progressive MCI; subjects that remained unchanged or improved during follow-up were considered as having stable MCI.

RESULTS: Subjects with progressive MCI (n = 39, 53%) were older (p = <0.001) and more educated (p = 0.01) compared to stable MCI (n = 35, 47%) and their global cognitive performances, at baseline, were more compromised when assessed by ADAS-Cog (p = 0.05). Antihypertensive drug prescription was greater in the stable MCI compared to progressive MCI (p = 0.01) and significant higher levels of plasma total homocysteine were observed in progressive MCI (p = 0.03). When analyzed in a logistic regression model, the prescription of Angiotensin Converting Enzyme Inhibitors (ACE) was found to be independently associated to the stability of cognitive function, whereas older age, higher education, higher levels of plasma total homocysteine and total ADAS-Cog basal score were independently associated with the progression of cognitive decline.

CONCLUSIONS: Older age, higher education, poor global cognitive performance, higher levels of plasma total homocysteine are independently associated with the progression of memory decline while the prescription of ACE Inhibitors is a protective factor for cognitive deterioration.