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Renin Angiotensin aldosterone system inhibition in controlling dementia-related cognitive decline
Rónán O'Caoimh1, Patrick Gavin Kehoe2, D William Molloy1
1Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork, Ireland.
Insights
Hypertension management, particularly using renin angiotensin aldosterone system (RAAS) inhibitors, may slow cognitive decline in mild cognitive impairment (MCI). Further randomized trials are needed to confirm these findings for dementia prevention.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Pharmacology
Background:
- Cognitive impairment and Alzheimer's disease present significant global health challenges.
- Current dementia treatments offer symptomatic relief but do not halt disease progression.
- Hypertension is an emerging modifiable risk factor for mild cognitive impairment (MCI).
Purpose of the Study:
- To review the complex relationship between the renin angiotensin aldosterone system (RAAS) and cognitive function.
- To explore the potential of RAAS-inhibiting medications in mitigating cognitive and functional decline.
- To highlight the need for randomized controlled trials in this area.
Main Methods:
- Review of preclinical and observational studies on RAAS inhibitors and cognitive function.
- Analysis of the central effects of angiotensin converting enzyme inhibitors and angiotensin receptor blockers.
- Discussion of the complexities and risks associated with RAAS inhibition in older adults.
Main Results:
- RAAS is central to blood pressure regulation.
- RAAS inhibitors show potential in reducing cognitive and functional decline in MCI and dementia.
- Evidence suggests potential central effects of RAAS inhibitors independent of blood pressure reduction.
Conclusions:
- RAAS inhibitors represent a potential therapeutic strategy for cognitive impairment.
- The benefits of RAAS inhibitors may vary, with risks of hypotension in older adults.
- High-quality randomized controlled trials are essential to validate current findings and guide clinical practice.
Abstract:
With the rising prevalence of cognitive impairment worldwide, clinicians are facing important challenges managing dementia, particularly Alzheimer's disease, the most prevalent dementia subtype. Given that current treatments mainly offer symptomatic improvement, without altering disease progression, the challenge now is to identify and integrate new therapeutic strategies. Hypertension is increasingly recognized as a modifiable risk factor for mild cognitive impairment (MCI), the precursor of dementia. The renin angiotensin aldosterone system (RAAS) is central to blood pressure regulation and medications targeting RAAS inhibition are associated with reduced rates of both cognitive and functional decline in those with MCI and dementia. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers are widely prescribed anti-hypertensives acting on the RAAS, and there is growing evidence that they act centrally, possibly exerting their effects independent of their blood pressure lowering properties. The relationship is complex however, and given the risks associated with hypotension particularly in older adults, treatment with these agents may not benefit all. Additionally, current evidence is limited to preclinical and observational studies such that there is now a pressing need to confirm preliminary studies with properly conducted randomized control trials. Here, we review some of the salient and complex aspects of these observations to date.
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