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Effects of Cardiovascular Medications on Rate of Functional Decline in Alzheimer Disease

https://doi.org/10.1097/JGP.0b013e318181276aGet rights and content

Background

Evidence suggests that cardiovascular medications, including statins and antihypertensive medications, may delay cognitive decline in patients with Alzheimer dementia (AD). We examined the association of cardiovascular medication use and rate of functional decline in a population-based cohort of individuals with incident AD.

Methods

In the Dementia Progression Study of the Cache County Study on Memory, Health, and Aging, 216 individuals with incident AD were identified and followed longitudinally with in-home visits for a mean of 3.0 years and 2.1 follow-up visits. The Clinical Dementia Rating (CDR) was completed at each follow-up. Medication use was inventoried during in-home visits. Generalized least-squares random-effects regression was performed with CDR Sum of Boxes (CDR-Sum) as the outcome and cardiovascular medication use as the major predictors.

Results

CDR-Sum increased an average of 1.69 points annually, indicating a steady decline in functioning. After adjustment for demographic variables and the baseline presence of cardiovascular conditions, use of statins (p = 0.03) and beta-blockers (p = 0.04) was associated with a slower annual rate of increase in CDR-Sum (slower rate of functional decline) of 0.75 and 0.68 points respectively, while diuretic use was associated with a faster rate of increase in CDR-Sum (p = 0.01; 0.96 points annually). Use of calcium-channel blockers, angiotensin-converting enzyme inhibitors, digoxin, or nitrates did not affect the rate of functional decline.

Conclusions

In this population-based study of individuals with incident AD, use of statins and beta-blockers was associated with delay of functional decline. Further studies are needed to confirm these results and to determine whether treatment with these medications may help delay AD progression.

Section snippets

Participant Screening

The DPS enrolls participants with incident dementia screened from the population of Cache County, Utah via procedures of the Cache County Study on Memory, Health, and Aging (CCSMHA). The protocols have been reported in detail elsewhere.21 Briefly, of the 5677 permanent residents of Cache County Utah aged 65 or older on January 1, 1995, 5092 (90%) enrolled in the study and underwent a multistage screening and assessment. Individuals with prevalent dementia were identified at the initial study

RESULTS

Of the 216 participants with incident AD and who had baseline CDR and MMSE scores, 135 (62.5%) had at least 1 additional follow-up. The flow chart for recruitment and attrition have been previously published.31 The attrition between baseline and follow-up was attributable to death in 59 participants, refusal in 11 participants, and not yet reached time for follow-up in 11 participants. The mean duration from baseline to follow-up visit was 1.6 years (SD 6.5), and subsequent visits were biennial

CONCLUSION

In a population-based sample of 216 participants with incident AD followed in a prospective longitudinal manner for a mean of 3.14 years, the use of statins and beta-blockers at baseline was associated with a slower rate of functional decline as measured by the CDR-Sum. CDR-Sum increased 1.69 points annually overall indicating that the typical course of AD in this cohort was progressive functional decline. This rate of decline was slower than the 2.9 point annual decline reported by Bhargava et

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    Statistical analyses performed by PBR and MMM.

    These results have been presented previously in part at the American College of Neuropsychopharmacology 45th Annual Meeting, Hollywood, Florida, December 3–7, 2006.

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