Acetylcholinesterase Inhibitors

Whilst the mainstay of management remains early and accurate diagnosis, with education and support for both the patient and family, first line treatment includes medical management with acetylcholinesterase inhibitors. These agents decrease the breakdown of acetylcholine, reducing the apparent deficiency of cholinergic activity associated with Alzheimer’s disease. 

Available acetylcholinesterase inhibitors in Australia:

• Donepezil (Aricept)
• Galantamine (Reminyl)
• Rivastigmine (Exelon patch)

It is important to note that these medications do not alter the pathology of Alzheimer’s disease. What they have been shown to provide is a temporary and modest improvement in symptoms, or delay in decline of cognitive function. These drugs improve alertness and function and can maintain cognitive scores at or above the baseline for up to 12 months. There is little evidence that any of the available agents is more efficacious than any other.

Evidence does not support prescribing these medications in all patients with Alzheimer’s disease, and not every patient prescribed these medications will have a beneficial response. Treatments should be reviewed at 3 months, where a beneficial effect may be expected. If there is poor adherence, significant adverse effects, or lack of stabilisation or improvement of symptoms, then consideration should be made to stop treatment.