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Progress in Clinical Neurosciences: Treatment of Alzheimer’s Disease and Other Dementias - Review and Comparison of the Cholinesterase Inhibitors

Published online by Cambridge University Press:  02 December 2014

David B. Hogan  and
Christopher Patterson
David B. Hogan
Affiliation:
Department of Medicine, University of Calgary, Calgary, Alberta, Canada
Christopher Patterson
Affiliation:
Division of Geriatric Medicine, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Abstract

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Background:

Alzheimer’s disease (AD) is the most common cause of dementia in older adults. Acceptance of the cholinergic hypothesis led to a search for medications which could enhance central cholinergic activity in this condition. There are now three cholinesterase inhibitors available for the treatment of AD in Canada.

Objectives:

To review the currently available cholinesterase inhibitors approved for the treatment of AD in Canada and to provide guidance on who and how to treat with these agents.

Results:

Donepezil, rivastigmine, and galantamine are approved for the treatment of AD in Canada. In clinical trails, patients with mild to moderate AD treated with these agents experienced modest improvements in cognition, function, behaviour, and/or global clinical state. The magnitude of benefits seen with each agent appeared to be similar. While to date, there is no convincing evidence that one is more efficacious or effective, they do differ in their pharmacokinetics, additional mechanisms of action, and side effect profiles. Therefore, the selection of agent will be based on considerations such as side effect profiles, ease of administration, personal familiarity/experience, and beliefs about the importance of the noted differences in their pharmacokinetics and additional mechanisms of action.

Conclusion:

We believe that these agents should be offered to all individuals with a mild to moderate dementia where Alzheimer’s pathology is felt to be a contributing factor. We view all three available cholinesterase inhibitors as first-line drugs.

Résumé:

RÉSUMÉ:Introduction:

La maladie d’Alzheimer (MA) est la cause la plus fréquente de démence chez les personnes âgées. L’acceptation de l’hypothèse cholinergique a mené à la recherche de medicaments qui pourraient augmenter l’activité cholinergique centrale dans cette maladie. Il y a maintenant trois inhibiteurs de la cholinestérase qui sont disponibles au Canada pour le traitement de la maladie d’Alzheimer.

Objectifs:

Revoir les inhibiteurs de la cholinestérase qui sont actuellement disponibles et approuvés pour le traitement de la MAau Canada et fournir des conseils sur le type de patient qui doit être traité par ces agents et sur la façon dont ces patients doivent être traités.

Résultats:

Le donépézil, la rivastigmine et la galantamine sont approuvés pour le traitement de la MAau Canada. Chez des patients sélectionnés, atteints de MAde légère à modérée, le traitement au moyen de ces agents produit des améliorations modestes de la cognition, du niveau fonctionnel, du comportement et/ou de l ’état clinique global. L’ampleur des bénéfices observés avec l ’un ou l ’ autre de ces agents paraît similaire. À date, il n’y a pas d’évidence convainquante qu ’un de ces agents soit plus efficace. Ils diffèrent quant à la pharmacocinétique, aux mécanismes d ’ action additionnels et au profil d’effets secondaires. Le choix d’un agent sera fondé sur des considérations telles que le profil d’effets secondaires, la facilité d’administration, la familiarité/l’expérience personnelle et les croyances sur l’importance de certaines différences dans la pharmacocinétique et les mécanismes d’action additionnels.

Conclusion:

Nous croyons que ces agents devraient être offerts à toutes les personnes ayant une démence légère à modérée, chez qui on croit que la MA est un facteur contributeur. Nous considérons les trois inhibiteurs de la cholinestérase présentement disponibles comme des médicaments de première ligne.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 29 , Issue 4 , November 2002 , pp. 306 - 314
Copyright
Copyright © The Canadian Journal of Neurological 2002

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