Cholinesterase inhibitors in the treatment of dementia
- Daniel Press, MD
Daniel Press, MD
- Assistant Professor in Neurology
- Harvard Medical School
- Michael Alexander, MD
Michael Alexander, MD
- Professor of Neurology
- Harvard Medical School
- Section Editors
- Steven T DeKosky, MD, FAAN, FACP, FANA
Steven T DeKosky, MD, FAAN, FACP, FANA
- Section Editor — Dementia
- Professor of Neurology
- Deputy Director
- McKnight Brain Institute
- University of Florida College of Medicine
- Kenneth E Schmader, MD
Kenneth E Schmader, MD
- Editor in Chief — Geriatric Medicine
- Section Editor — Geriatrics
- Chief, Division of Geriatrics
- Duke University
- Director, Geriatric Research Education and Clinical Center
- Durham VA Medical Centers
Cholinesterase inhibitors and memantine are the only currently available symptomatic medications for cognition and global functioning in patients with dementia. Cholinesterase inhibitors target the acetylcholine deficit arising from loss of neurons in the nucleus basalis of Meynert and its projections in patients with dementia. They are considered symptomatic therapies and are not believed to be neuroprotective or to alter the underlying disease trajectory.
This topic will discuss the use of cholinesterase inhibitors in the treatment of dementia. Topics on other aspects of the treatment of dementia include:
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- PATIENT SELECTION AND DEMENTIA ETIOLOGY
- DEGREE OF BENEFIT
- Mild to moderate dementia
- Advanced disease
- CHOICE OF DRUG
- Contraindications and precautions
- Specific drugs
- - Donepezil
- - Galantamine
- - Rivastigmine
- Approach to common side effects
- - Nausea and diarrhea
- - Anorexia and weight loss
- - Bradycardia and hypotension
- - Sleep disturbances
- FOLLOW-UP AND MONITORING
- Assessment of response
- Duration of therapy
- - Patients who do not respond initially
- - Other reasons for discontinuation
- - Patients who worsen when drug is stopped
- Role of memantine
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS