Acetylcholinesterase Inhibitors May Be Another Piece In Alzheimer's Jigsaw

(Efficacy and safety of rivastigmine in patients with Alzheimer's disease: international randomised controlled trial)

Acetylcholinesterase inhibitors, such as tacrine and donepezil, which have been designed to boost the apparent chemical deficiency in the brain caused by Alzheimer's disease, are the most successful treatments to date. In this week's BMJ Professor Michael Rsler from Psychiatrische Universittsklinik, Germany and colleagues report the finding of the first large trial of another acetylcholinesterase inhibitor used by patients suffering from Alzheimer's, in a mainly European population.

The authors' six month trial involved the drug rivastigmine and they found that it was effective in treating some of the symptoms of patients with mild or moderate Alzheimer's disease. The research team also discovered that the effects of rivastigmine seem to be dose dependent - those patients receiving a higher dose of the drug showed clinically relevant (and statistically significant) improvements.

Rsler et al draw attention to the gastrointestinal side-effects experienced by some patients (27 per cent of those taking the higher dose of rivastigmine discontinued treatment owing to adverse effects), but report that these effects were mild and short lived and only occurred after the dosage had been increased.

In an accompanying commentary, Dr Tony Bayer from the University of Wales College of Medicine writes that the research by Rsler et al provides another piece in the Alzheimer's jigsaw, but also reports some of the shortcomings of their study. Bayer says that the patients who participated in the trial were not typical of those generally seen by psychiatrists and geriatricians and he says that the absence of measures of the neuropsychiatric effect of the drug is "unfortunate". Bayer also reports that the study "....tells us nothing about the long term impact of acetylcholinesterase inhibitor treatment or the considerable human

Contact: Jill Shepherd
BMJ-British Medical Journal

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