Memory cholinesterase inhibitors

Alzheimer s Disease This disease is due to the accumulation of j8-amyloid protein in the brain. The protein is believed to trigger brain degeneration through cell death of the neurons. Alzheimer s disease is characterized by loss of memory and intellectual performance, and slowness in thought. In the United States, a class of drugs called cholinesterase inhibitors is approved to treat Alzheimer s disease. Both Europe and the United States have approved a drug called memantine for treatment of Alzheimer s disease. 

Donepezil, rivastigmine and galanfamine are the three available cholinesterase inhibitor (ChEI) and all work by inhibiting the breakdown of acetylcholine, an important neurotransmitter associated with memory, by blocking the enzyme. 

C. Cholinesterase inhibitors as treatments for enhancing memory or slowing the pace of memory loss in Alzheimer s disease... 

Cholinesterase Inhibitors as Treatments for Enhancing Memory or Slowing the Pace of Memory Loss in Alzheimer s Disease... 

Tacrine was the first cholinesterase inhibitor approved for the enhancement of memory associated with Alzheimer s disease in the United States. Because of its short half-life, drug interactions, and hepatic toxicity, it is currently considered second-line therapy for patients who fail to respond to donepezil. Its psychophar-... 

FIGURE 12-30. Alzheimer s disease pharmacy. Currently, donepezil is first-line for memory loss, and atypical antipsychotics (SDA) are first-line for positive psychotic symptoms together they may work synergistically. Soon the cholinesterase inhibitors metrifonate and/or rivastigmine may become available. Second-line treatments are tacrine for memory and conventional antipsychotics (D2) for positive psychotic symptoms. Several other agents are in clinical and preclinical development. 

FIGURE 12—32. The best responses to cholinesterase inhibitor therapy in Alzheimer s disease can be substantial improvement, large enough to be noticeable to the patient and to his or her caregiver within weeks of initiation of therapy. Some of these patients sustain this robust improvement for many months or have a noticeably slower than expected decline in memory. 

Cholinesterase inhibitors one class of six drugs or six unique agents Soon three to six cholinesterase inhibitors should be available worldwide for the treatment of cholinergic-related memory disturbances in Alzheimer s disease (Fig. 12—30). Use of these agents will likely be expanded to treat cholinergic-related behavioral disturbances in Alzheimer s disease in addition to memory disturbances, since there is evidence that behavioral problems in this disease may also respond to cholinergic... 

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