The effects of centrally acting ACE inhibitors on the rate of cognitive and functional decline in dementia: a KDD approach

Alzheimer’s Disease and other dementias are one of the most challenging illnesses confronting countries with ageing populations. Treatment options for dementia are limited, and the costs are significant. There is a growing need to develop new treatments for dementia, especially for the elderly. There is also growing evidence that centrally acting angiotensin converting enzyme (ACE) inhibitors, which cross the blood-brain barrier, are associated with a reduced rate of cognitive and functional decline in dementia, especially in Alzheimer’s disease (AD). The aim of this research is to investigate the effects of centrally acting ACE inhibitors (CACE-Is) on the rate of cognitive and functional decline in dementia, using a three phased KDD process. KDD, as a scientific way to process and analysis clinical data, is used to find useful insights from a variety of clinical databases. The data used are from three clinic databases: Geriatric Assessment Tool (GAT), the Doxycycline and Rifampin for Alzheimer’s Disease (DARAD), and the Qmci validation databases, which were derived from several different geriatric clinics in Canada. This research involves patients diagnosed with AD, vascular or mixed dementia only. Patients were included if baseline and end-point (at least six months apart) Standardised Mini-Mental State Examination (SMMSE), Quick Mild Cognitive Impairment (Qmci) or Activities Daily Living (ADL) scores were available. Basically, the rates of change are compared between patients taking CACE-Is, and those not currently treated with CACE-Is. The results suggest that there is a statistically significant difference in the rate of decline in cognitive and functional scores between CACE-I and NoCACE-I patients. This research also validates that the Qmci, a new short assessment test, has potential to replace the current popular screening tests for cognition in the clinic and clinical trials.

Rural change south of the river Bride in counties Cork and Waterford: the surveyors' evidence 1716–1851

Estate studies in Irish historical geography have been often designed to confirm or contrast local trends of development with those previously identified at the regional or sub-regional level. To date, little attention has been awarded to estate maps in studies of rural landscape change. It is a theme of this paper that the results yielded from a careful study of such estate maps can throw light on the results of the activities of the majority of estate residents. In this regard, it is fortunate that at Lismore surveys of the estate in 1716–17 and 1773–4 have survived, and a nineteenth century dimension is added by an analysis of the Valuation Office maps for 1851. This work is focused on a study of critical indicators of change, notably leasing arrangements, farm size, rate and type of enclosure, infrastructural development and settlement growth. These changes are reviewed within the framework of the dialectic that developed between landlord or landlord-inspired management policies and the forces released locally by the vast bulk of the population. Broadly this analysis indicates some of the potential rewards which may be secured by detailed scrutiny of estate maps in conjunction with other estate records.