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Cholinesterase inhibitors may help in mild Alzheimer's

Cholinesterase inhibitor drugs donepezil (Aricept), galantamine (Reminyl) and rivastigmine (Exelon) can provide improved cognitive function, daily activity and behaviour to Alzheimer's disease patients with mild to moderate dementia, according to a review published online in The Cochrane Database of Systematic Reviews (25 January).

Jacqueline Birks, a medical statistician from the Cochrane Dementia and Cognitive Improvement Group at the University of Oxford, found that there was no clear differences between the three agents in terms of efficacy. Data suggest that donepezil has a superior adverse reaction profile, but Ms Birks postulates that galantamine and rivastigmine could have similar tolerability if doses were carefully and slowly adjusted over at least three months.

The systematic review offers some credence to the draft National Institute for Health and Clinical Excellence review that changes its preliminarily negative stance on the agents being available to NHS patients. However, Ms Birks suggests that NICE might have gone further. She told The Journal that, although there was little evidence to support the use of the agents in severe disease, they might have a place in mild disease. “Cholinesterase inhibitors have been shown to be effective in people with mild to moderate disease. And since patients with mild Alzheimer’s disease could benefit, that is, patients with a mini mental score higher than 20, there is no reason why they should be denied treatment with a cholinesterase inhibitor. The earlier the treatment is used in the disease, the longer the patient could benefit in terms of improved memory, more independence and less need for help and support”.

Citation: The Pharmaceutical Journal URI: 10020833

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