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”. |
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