ACE inhibitors & dementia

Introduction

ACE inhibitors as a class do not appear to be independently associated with cognitive decline in the elderly. However, there may be an association if the data is examined after separating centrally-active ACE inhibitors (captopril, fosinopril, lisinopril, perindopril, ramipril, & trandolapril) which cross the blood-brain barrier from those that do not (benazepril, enalapril, moexipril, & quinapril do not). Centrally-active ACE inhibitors appear to slow cognitive impairment & non centrally-active agents appear to accelerate it. Further confirmation needed.