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Cholinesterase inhibitors and memantine have a role in the treatment of Alzheimer's disease

Nature Clinical Practice Neurology volume 2, pages 578–579 (2006)Cite this article

Several principles underlie the selection of therapies for the treatment of any medical condition. First, the treatment should have demonstrated efficacy. Second, the data on the efficacy and safety should be reviewed by scientific panels of experts and, where appropriate, governmental approval agencies; clinicians should exercise caution with treatments that have not undergone such review or received such approval. Third, when treatments are comparable in efficacy, safety considerations become paramount. Last, in the presence of several treatments with similar efficacy and safety, the choice of treatment should be left to the patient or surrogate decision maker.

We believe that the FDA-approved cholinesterase inhibitors donepezil, rivastigmine and galantamine (listed in order of approval), and the N-methyl-D-aspartate (NMDA) antagonist memantine meet the above criteria, and therefore have a role to play in the treatment of Alzheimer's disease (AD). We come to this conclusion for two reasons. First and foremost, there is now an extensive literature demonstrating the modest efficacy of these drugs for improving the cognitive and global functioning impairments that define dementia in research subjects with AD.1,2 Second, these drugs are relatively safe—they have few serious adverse side effects, and the common adverse effects are reversible on cessation of the drugs. These facts have now been recognized by the US FDA, as well as in practice guidelines developed by a variety of professional organizations.3,4 A re-review of the drugs by the UK National Institute for Health and Clinical Excellence is currently underway.

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Authors and Affiliations

  1. professor of psychiatry, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD, USA

    Peter V Rabins

  2. professor of psychiatry and mental health, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD, USA

    Constantine G Lyketsos

Authors
  1. Peter V Rabins
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  2. Constantine G Lyketsos
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Corresponding author

Correspondence to Peter V Rabins.

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Competing interests

Peter Rabins has received speaking honoraria from AstraZeneca, Eli Lilly, Forest Laboratories, Janssen Pharmaceutica and Pfizer.

Constantine Lyketsos has received research funding and educational fees from Abbott Laboratories, AstraZeneca, Bristol–Myers Squibb, Eisai, Eli Lilly, GlaxoSmithKline, Janssen Pharmaceutica and Pfizer, and consulting or advisory board fees from Eisai, Forest Laboratories, GlaxoSmithKline, Janssen Pharmaceutica and Novartis, and lecture fees from Forest Laboratories, Lundbeck and Pfizer.

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Rabins, P., Lyketsos, C. Cholinesterase inhibitors and memantine have a role in the treatment of Alzheimer's disease. Nat Rev Neurol 2, 578–579 (2006). https://doi.org/10.1038/ncpneuro0269

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