Cholinesterase inhibitors in Alzheimer’s disease
DOI:
https://doi.org/10.25118/2236-918X-5-3-3Keywords:
Alzheimer’s disease, treatment, cholinesterase inhibitorsAbstract
Alzheimer’s disease (AD) is the most common cause of dementia, characterized by an insidious onset and a progressive course, with cognitive decline, impairment of autonomy and of the ability to perform activities of daily living, mood swings and changes in behavior. Throughout the course of the disease, clinical manifestations of various kindscan be observed: cognitive manifestations, e.g., memory loss, impaired language, visual-spatial, and constructional skills, and executive function, among others; behavioral problems, e.g., depression, anxiety, violent/agitated behavior; insomnia; impaired ability to perform activities of daily living; impact
on independence and quality of life of patients and their caregivers. At present, AD treatment is based on the use of cholinesterase inhibitors, with the aim to stabilize or slow the course of the disease. The available evidence suggests an average improvement of -2.7 points (95% confidence interval: -3.0 to -2.3) in the range of 70 points on the Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-cog) for 6 months to 1 year in patients with mild, moderate, and severe dementia, as well as a better control of associated behavioral symptoms. This article reviews recent data on the use of cholinesterase inhibitors in AD, the moment of their introduction, treatment duration, and primary effectiveness markers.
Downloads
Metrics
References
Rountree SD, Chan W, Pavlik VN, Darby EJ, Siddiqui S, Doody RS. Persistent treatment with cholinesterase inhibitors and/or memantine slows clinical progression of Alzheimer disease. Alzheimers Res Ther. 2009;1:7.
Nitrini R, Caramelli P, Herrera E Jr, Bahia VS, Caixeta LF, Radanovic M, et al. Incidence of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord. 2004;18:241-6.
Chaves ML, Camozzato AL, Godinho C, Piazenski I, Kaye J. Incidence of mild cognitive impairment and Alzheimer disease in Southern Brazil. J Geriatr Psychiatry Neurol. 2009;22:181-7.
Brasil, Ministério da Saúde, Secretaria de Atenção à Saúde. Protocolo clínico e diretrizes terapêuticas na doença de Alzheimer. Portaria nº 1.298, de 21 de novembro de 2013 [Internet]. 2010 Sep 23. http://bvsms.saude.gov.br/bvs/saudelegis/sas/2013/prt1298_21_11_2013.html
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology. 1984;34:939-44.
Dubois B, Feldman HH, Jacova C, Cummings JL, Dekosky ST, Barberger-Gateau P, et al. Revising the definition of Alzheimer’s disease: a new lexicon. Lancet Neurol. 2010;9:1118-27.
McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR Jr, Kawas CH, et al. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7:263-9.
Laks J, Marinho V, Engelhardt E. Diagnóstico clínico da doença de Alzheimer. In: Blay SL, Laks J, Bottino CMC, editores. Demência e transtornos cognitivos em idosos. Rio de Janeiro: Guanabara; 2006. p. 173-6.9. Mangialasche F, Kivipelto M, Solomon A, Fratiglioni L. Dementia prevention: current epidemiological evidence and future perspective. Alzheimers Res Ther. 2012;4:6.
Vellas B. Update on prevention trials in Alzheimer’s disease. J Prev Alzheimers Dis. 2014;1:168-75.
Marinho V. Demência frontotemporal. In: Blay SL, Laks J, Bottino CMC, editores. Demência e transtornos cognitivos em idosos. Rio de Janeiro: Guanabara; 2006. p. 196-10.
Hototian SR, Bottino CMC, Azevedo D. Critérios e instrumentos para o diagnóstico da síndrome demencial. In: Blay SL, Laks J, Bottino CMC, editores. Demência e transtornos cognitivos em idosos. Rio de Janeiro: Guanabara; 2006. p. 51-66.
Ferraz HB. Demência na doença de Parkinson. In: Blay SL, Laks J, Bottino CMC, editores. Demência e transtornos cognitivos em idosos. Rio de Janeiro: Guanabara; 2006. p. 222-6.
Engelhardt E, Tocquer C, André C, Moreira DM, Okamoto IH, Cavalcanti JLS. Demência vascular. Critérios diagnósticos e exames complementares. Dement Neuropsychol. 2011;5:49-77.
Caramelli P, Teixeira AL, Buchpiguel CA, Lee HW, Livramento JA, Fernandez LL, et al. Diagnóstico de doença de Alzheimer no Brasil: exames complementares. Dement Neuropsychol. 2011;5:11-20.
Tan CC, Yu JT, Wang HF, Tan MS, Meng XF, Wang C, et al. Efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer’s disease: a systematic review and metaanalysis. J Alzheimers Dis. 2014;41:615-31.
Birks J. Cholinesterase inhibitors for Alzheimer’s disease. Cochrane Database Syst Rev. 2006;1:CD005593.
Rountree SD, Atri A, Lopez OL, Doody RS. Effectiveness of antidementia drugs in delaying Alzheimer’s disease progression. Alzheimers Dement. 2013;9:338-45.
Olazarán J, Navarro E, Rojo JM. Persistence of cholinesterase inhibitor treatment in dementia: insights from a naturalistic study. Dement Geriatr Cogn Dis Extra. 2013;3:48-59.
Howard R, McShane R, Lindesay J, Ritchie C, Baldwin A, Barber R, et al. Donepezil and memantine for moderate-to-severe Alzheimer’s disease. N Engl J Med. 2012;366:893-903.
Kavirajan H, Schneider LS. Efficacy and adverse effects of cholinesterase inhibitors and memantine in vascular dementia: a meta-analysis of randomized controlled trials. Lancet Neurol. 2007;6:782-92.
Rolinski M, Fox C, Maidment I, McShane R. Cholinesterase inhibitors for dementia with Lewy bodies, Parkinson’s disease dementia and cognitive impairment in Parkinson’s disease. Cochrane Database Syst Rev. 2012;3:CD006504.
Portugal Mda G, Marinho V, Laks J. Pharmacological treatment of frontotemporallobar degeneration: systematic review. Rev Bras Psiquiatr. 2011;33:81-90.
Russ TC, Morling JR. Cholinesterase inhibitors for mild cognitive impairment. Cochrane Database Syst Rev. 2012;9:CD009132.
Brasil, Ministério da Saúde, Agência Nacional de Vigilância Sanitária (ANVISA). Hemitartarato de rivastigmina [Internet]. http://www.anvisa.gov.br/datavisa/fila_bula/frmVisualizarBula.asp?pNuTransacao=5227332014&pIdAnexo=2105007
Brasil, Ministério da Saúde, Agência Nacional de Vigilância Sanitária (ANVISA). Lábrea (cloridrato de donepezila) [Internet]. http://www.anvisa.gov.br/datavisa/fila_bula/frmVisualizarBula.asp?pNuTransacao=10048142013&pIdAnexo=1883346
Brasil, Ministério da Saúde, Agência Nacional de Vigilância Sanitária (ANVISA). Reminyl® ER (bromidrato de galantamina) [Internet]. http://www.anvisa.gov.br/datavisa/fila_bula/frmVisualizarBula.asp?pNuTransacao=10740862013&pIdAnexo=1910796.
Birks J, Grimley Evans J, Iakovidou V, Tsolaki M, Holt FE. Rivastigmine for Alzheimer’s disease. Cochrane Database Syst Rev. 2009;2:CD001191.
Downloads
Published
How to Cite
Conference Proceedings Volume
Section
License
Copyright (c) 2015 Kellen Klein Pereira, Valeska Marinho Rodrigues
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Debates em Psiquiatria allows the author (s) to keep their copyrights unrestricted. Allows the author (s) to retain their publication rights without restriction. Authors should ensure that the article is an original work without fabrication, fraud or plagiarism; does not infringe any copyright or right of ownership of any third party. Authors should also ensure that each one complies with the authorship requirements as recommended by the ICMJE and understand that if the article or part of it is flawed or fraudulent, each author shares responsibility.
Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) - Debates em Psiquiatria is governed by the licencse CC-By-NC
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material
The licensor cannot revoke these freedoms as long as you follow the license terms. Under the following terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- NonCommercial — You may not use the material for commercial purposes.
No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
