Older adults taking medications for hypertension, high cholesterol, and diabetes had slower cognitive decline and fewer dementia-related brain changes, according to research presented at the Alzheimer’s Association International Conference (AAIC) 2025.

The study involved 4,651 older adults without dementia at baseline from five aging cohort studies. All participants underwent at least two yearly cognitive assessments. Medication use was reviewed annually and categorized by the number of drug classes taken:  anti-hypertensive, lipid-lowering, and anti-diabetes agents.

Triple therapy – using all three medication classes – was linked with a slower decline of overall cognition, particularly in semantic and working memory.

Among 1,896 participants who later died and underwent brain autopsies, those on triple therapy showed: 

• Lower odds of atherosclerosis and arteriolosclerosisd

• Less global Alzheimer disease (AD) pathology, included reduced levels of amyloid plaques and neurofibrillary tangles.

• Lower odds of TDP-43 protein buildup and hippocampal sclerosis

However, triple therapy was also associated with a higher risk of brain infarcts, especiallymacroinfarcts.

Dual therapy – using two of the three medication classes – was also linked with slower global cognitive decline across episodic, semantic, and working memory. In the autopsied group, it was associated with lower odds of atherosclerosis, reduced global AD pathology, fewer tangles, and reduced TDP-43 pathology.

Single-class therapy was linked to slower decline in semantic memory and, in deceased participants, fewer tangles and lower odds of TDP-43 pathology.

Analyses accounted for demographic differences, and brain examinations looked for signs of Alzheimer disease, vascular disease, and other dementia-related changes.

The results point to possible associations between multi-class cardiovascular therapies and slower cognitive decline, though infarct risk may also increase with combination use.