Cholinesterase Inhibitors
Cholinesterase inhibitors are a class of medications commonly prescribed to help manage the symptoms of Alzheimer’s disease, as well as Parkinson’s or Lewy Body Dementia.
They do not help vascular or alcoholic dementia, and can make frontal dementia worse.
These meds, including Donepezil, Rivastigmine, and Galantamine, work by increasing levels of acetylcholine, a protein in nerve cells responsible for cell communication.
By boosting this neurotransmitter, these medications can help slow down the progression of symptoms like memory loss and confusion in about 30% of those treated. The effect can be modest for some, delaying admission to a nursing home by six months, to dramatic; cutting out serious delusions that may make an elder miserable. Each of these meds has its unique benefits and potential side effects, making it important to understand how they work and which one may be the best fit for each patient.
Let’s take a closer look at these key treatments.
Cholinesterase Inhibitors Drugs
Donepezil (Aricept)
The most well-known med for dementia is Donepezil (Aricept), an anticholinesterase inhibitor. It increases the concentration of acetylcholine, which affects memory and reasoning.
Studies show that this class of drugs may modestly help slow the rate of decline and possibly keep the nursing home at bay for an extra six months. However, the drugs only help 10 to 30 percent of those with dementia, and it’s impossible to know which individuals will benefit.
Donepezil is not a cure-all. While it is perhaps the best studied of the dementia meds, its use remains controversial. It may help brain function and slow the progression of Alzheimer’s. Studies show better effects in improvement for Parkinson’s disease. Conversely, this medication should not be used for Frontal dementia.
In addition, Donepezil’s side effects may be uncomfortable and occasionally, serious; insomnia, nausea, loss of appetite, diarrhea, and decreased blood pressure and heart rate. Occasionally, the drug causes behavioral problems, such as agitation or sedation. Still, donepezil is certainly worth trying, particularly a low dose in the morning.
Several similar meds also affect choline and memory.
Rivastigmine (Exelon)
This medication is another anticholinesterase inhibitor, and may be better tolerated than Donepezil. This drug may be delivered by a skin patch as well as a pill. The patch may be especially useful for patients who suffer from diarrhea, nausea or loss of appetite. However, with patch delivery method, the drug may make balance worse. With medications, there are always tradeoffs.
Galantamine (Razadyne)
This drug has side effects similar to donepezil. Some patients suffer from agitated behavior. Others don’t seem to enjoy any benefit.