Limits...
Current pharmacologic options for patients with Alzheimer's disease.

Reichman WE - Ann Gen Hosp Psychiatry (2003)

Bottom Line: In the United States, there are four AChEIs approved for the treatment of AD: tacrine, donepezil, rivastigmine, and galantamine.There are other agents under investigation, but at present, AChEIs are the only approved drug category for AD treatment.MEASUREMENTS AND MAIN RESULTS: AD is becoming a major public health concern and underdiagnosis is a significant problem (with only about half of AD patients being diagnosed and only half of those diagnosed actually being treated).

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103. reichman@umdnj.edu

ABSTRACT
BACKGROUND: The aim of the current study was to provide general practitioners with an overview of the available treatment options for Alzheimer's disease (AD). Since general practitioners provide the majority of medical care for AD patients, they should be well versed in treatment options that can improve function and slow the progression of symptoms. DESIGN: Biomedical literature related to acetylcholinesterase inhibitors (AChEIs) was surveyed. In the United States, there are four AChEIs approved for the treatment of AD: tacrine, donepezil, rivastigmine, and galantamine. There are other agents under investigation, but at present, AChEIs are the only approved drug category for AD treatment. MEASUREMENTS AND MAIN RESULTS: AD is becoming a major public health concern and underdiagnosis is a significant problem (with only about half of AD patients being diagnosed and only half of those diagnosed actually being treated). Clinical trials have demonstrated that patients with AD who do not receive active treatment decline at more rapid rates than those who do. CONCLUSIONS: Given that untreated AD patients show decline in three major areas (cognition, behavior, and functional ability), if drug treatment is able to improve performance, maintain baseline performance over the long term, or allow for a slower rate of decline in performance, each of these outcomes should be viewed a treatment success.

No MeSH data available.


Related in: MedlinePlus

Galantamine proposed mechanisms of action: acetylcholinesterase inhibition and allosteric nicotinic modulation [14,37].
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC149431&req=5

Figure 4: Galantamine proposed mechanisms of action: acetylcholinesterase inhibition and allosteric nicotinic modulation [14,37].

Mentions: Approved by the FDA in February 2001, galantamine is the newest AChEI to be introduced. It is a novel drug with a dual mechanism of action: competitive inhibition of AChE and allosteric modulation of nicotinic receptors (Figure 4) [14,37]. While the clinical significance of nicotinic modulation for the treatment of AD may not be fully elucidated, it is clear that nicotinic receptors play a role in cognition. Presynaptic nicotinic receptors control the release of neurotransmitters that are important for memory and mood (eg, ACh, glutamate, serotonin, norepinephrine) [38]. It has been shown that blocking nicotinic receptors impairs cognition [39], and selective interaction with nicotinic receptor subtypes improves cognitive function and memory [39,40].


Current pharmacologic options for patients with Alzheimer's disease.

Reichman WE - Ann Gen Hosp Psychiatry (2003)

Galantamine proposed mechanisms of action: acetylcholinesterase inhibition and allosteric nicotinic modulation [14,37].
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC149431&req=5

Figure 4: Galantamine proposed mechanisms of action: acetylcholinesterase inhibition and allosteric nicotinic modulation [14,37].
Mentions: Approved by the FDA in February 2001, galantamine is the newest AChEI to be introduced. It is a novel drug with a dual mechanism of action: competitive inhibition of AChE and allosteric modulation of nicotinic receptors (Figure 4) [14,37]. While the clinical significance of nicotinic modulation for the treatment of AD may not be fully elucidated, it is clear that nicotinic receptors play a role in cognition. Presynaptic nicotinic receptors control the release of neurotransmitters that are important for memory and mood (eg, ACh, glutamate, serotonin, norepinephrine) [38]. It has been shown that blocking nicotinic receptors impairs cognition [39], and selective interaction with nicotinic receptor subtypes improves cognitive function and memory [39,40].

Bottom Line: In the United States, there are four AChEIs approved for the treatment of AD: tacrine, donepezil, rivastigmine, and galantamine.There are other agents under investigation, but at present, AChEIs are the only approved drug category for AD treatment.MEASUREMENTS AND MAIN RESULTS: AD is becoming a major public health concern and underdiagnosis is a significant problem (with only about half of AD patients being diagnosed and only half of those diagnosed actually being treated).

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103. reichman@umdnj.edu

ABSTRACT
BACKGROUND: The aim of the current study was to provide general practitioners with an overview of the available treatment options for Alzheimer's disease (AD). Since general practitioners provide the majority of medical care for AD patients, they should be well versed in treatment options that can improve function and slow the progression of symptoms. DESIGN: Biomedical literature related to acetylcholinesterase inhibitors (AChEIs) was surveyed. In the United States, there are four AChEIs approved for the treatment of AD: tacrine, donepezil, rivastigmine, and galantamine. There are other agents under investigation, but at present, AChEIs are the only approved drug category for AD treatment. MEASUREMENTS AND MAIN RESULTS: AD is becoming a major public health concern and underdiagnosis is a significant problem (with only about half of AD patients being diagnosed and only half of those diagnosed actually being treated). Clinical trials have demonstrated that patients with AD who do not receive active treatment decline at more rapid rates than those who do. CONCLUSIONS: Given that untreated AD patients show decline in three major areas (cognition, behavior, and functional ability), if drug treatment is able to improve performance, maintain baseline performance over the long term, or allow for a slower rate of decline in performance, each of these outcomes should be viewed a treatment success.

No MeSH data available.


Related in: MedlinePlus