Cholinesterase inhibitors: Aricept, Exelon, Razadyne

Cholinesterase inhibitors (AchEI) increase the amount of acetylcholine in the brain, in an effort to compensate for loss of nerve cells that normally produce this messenger molecule. There are three AchEI’s on the market – Aricept, Exelon and Razadyne and they are approved to treat mild to moderate Alzheimer’s disease (AD). Aricept recently received FDA approval to treat severe AD.

Clinical trials have shown AchEI’s are safe and moderately effective. They do not stop the progression of AD, but they can delay the symptoms of cognitive decline, preserve function, and may help alleviate troublesome behaviors. Benefits can extend beyond two to three years, and those who get treatment sooner do better in the long run.

Patients who do not take the same medication would get worse more rapidly and become completely dependent on others sooner. Thanks to these medications, patients can stay with their families for one to two years longer before needing additional care. Also, studies have shown these medications can be used for treatment of other forms of dementia.

Namenda:

Namenda has a unique mechanism of action. It is an inhibitor of the neuromessenger Glutamate, which in AD overexcites nerve cells to death (excitotoxicity). It is indicated to treat moderate to severe AD and may be used alone or in combination with an AchEI. It is generally well tolerated.

Studies show Memantine has positive effects on cognition, function and behavior, especially when used in conjunction with an AchEI.