Skip to main content
Article thumbnail
Location of Repository

Progress update: Pharmacological treatment of Alzheimer’s disease

By David B Hogan


A number of drugs have been approved for the treatment of Alzheimer’s disease (AD) and a larger number are being studied as possible therapies. The current mainstays of the pharmacotherapy of AD are the cholinesterase inhibitors (donepezil, galantamine, rivastigmine) and memantine. They collectively have acceptable tolerability and proven but modest efficacy. The agents being studied include dietary supplements (eg, vitamin E), herbal preparations (eg, Ginkgo biloba), medications approved for other indications (eg, HMG-CoA reductase enzyme inhibitors) and research drugs. In this review we discuss in detail the approved agents and review a number of the unapproved therapies that are currently available to the practitioner. While our era offers much more in the way of therapeutics for AD, it is clear that more work still needs to be done

Topics: Reviews
Publisher: Dove Medical Press
OAI identifier:
Provided by: PubMed Central
Download PDF:
Sorry, we are unable to provide the full text but you may find it at the following location(s):
  • http://www.pubmedcentral.nih.g... (external link)
  • Suggested articles


    1. (2000). A 5-month, randomized, placebo-controlled trial of galantamine in AD.
    2. (2007). A brief review of the pharmacologic and therapeutic aspects of memantine in Alzheimer’s disease. Expert Opin Drug Metab Toxicol,
    3. (2002). A case-control analysis of nonsteroidal anti-infl ammatory drugs and Alzheimer’s disease: are they protective?
    4. (1997). A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer’s disease.
    5. (1999). A double-blind, placebocontrolled trial of diclofenac/misoprostol in Alzheimer’s disease.
    6. (2003). A pilot study on the effects of testosterone in hypogonadal aging male patients with Alzheimer’s disease. Aging Male,
    7. (2005). A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs.
    8. (2000). A randomized controlled trial of prednisone in Alzheimer’s disease.
    9. (2005). A randomized, doubleblind, placebo-controlled trial of two doses of ginkgo biloba extract in dementia of the Alzheimer’s type. Curr Alz Res,
    10. (2006). A responder analysis of memantine treatment in patients with Alzheimer disease maintained on donepezil.
    11. (2006). Adding memantine to rivastigmine therapy in patients with mild-to-moderate Alzheimer’s disease: results of a 12-week, open-label pilot study.
    12. (2003). Androgens modulate neuronal vulnerability to kainite lesion.
    13. (1996). Arthritis and anti-infl ammatory agents as possible protective factors for Alzheimer’s disease: A review of 17 epidemiologic studies.
    14. (2005). Atorvastatin for the treatment of mild to moderate Alzheimer disease: preliminary results.
    15. (2005). Causes of syncope in patients with Alzheimer’s disease treated with donepezil. Drugs Aging,
    16. (2006). Cholinesterase inhibitors for Alzheimer’s disease. Cochrane Database Syst Rev,
    17. (2005). Cholinesterase inhibitors for patients with Alzheimer’s disease: systematic review of randomised clinical trials.
    18. (2003). Chronic exposure to anticholinergic medications adversely affects the course of Alzheimer disease.
    19. (2002). Clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for Alzheimer’s disease. A systematic review.
    20. (1993). Clinical trial of indomethacin in Alzheimer’s disease.
    21. (2003). Co-use of donepezil and hypnotics among Alzheimer’s disease patients living in the community.
    22. (2004). Comparison studies of cholinesterase inhibitors for Alzheimer’s disease. Lancet Neurol,
    23. (2006). Complete atrioventricular block and ventricular tachyarrhythmia associated with donepezil.
    24. (2005). Decreased persistence to cholinesterase inhibitor therapy with concomitant use of drugs that can impair cognition.
    25. (2004). Donepezil and cardiac syncope: case report.
    26. (2002). Donepezil and rivastigmine in the treatment of Alzheimer’s disease: a best-evidence synthesis of the published data on their effi cacy and cost-effectiveness. Clin Ther,
    27. (2006). Donepezil for dementia due to Alzheimer’s disease. Cochrane Database Syst Rev,
    28. (2004). Donepezil for the symptomatic treatment of patients with mild to moderate Alzheimer’s disease: a meta-analysis of individual patient data from randomised controlled trials.
    29. (2006). Donepezil in patients with severe Alzheimer’s disease: double-blind, parallel-group, placebocontrolled study.
    30. (2006). Donepezil markedly potentiates memantine neurotoxicity in the adult rat brain. Neurobiol Aging, [Epub ahead of print].
    31. (2001). Effect of hydroxychloroquine on progression of dementia in early Alzheimer’s disease: an 18-month randomised, double-blind, placebo-controlled study.
    32. (2007). Effective pharmacologic management of Alzheimer’s disease.
    33. (2003). Effects of rofecoxib or naproxen vs placebo on Alzheimer disease progression: a randomized controlled trial.
    34. (2007). Effects of statins on cognitive function in patients with Alzheimer’s disease in galantamine clinical trials. Drugs Aging,
    35. (2005). Effects of switching from an AChE inhibitor to a dual AChE-BuChE inhibitor in patients with Alzheimer’s disease. Curr Med Res Opin,
    36. (2003). Effi cacy and safety of cholinesterase inhibitors in Alzheimer’s disease: a meta-analysis.
    37. (2002). Effi cacy and safety of rivastigmine in patients with Alzheimer’s disease who failed to benefi t from treatment with donepezil. Curr Med Res Opin,
    38. (2003). Effi cacy of cholinesterase inhibitors in the treatment of neuropsychiatric symptoms and functional impairment in Alzheimer disease: a meta-analysis.
    39. (2002). Fatal aspiration pneumonia during transition from donepezil to rivastigmine. Ann Pharmacother,
    40. (2003). Folic acid with or without vitamin B12 for cognition and dementia. Cochrane Database Syst Rev,
    41. (2006). for Health and Clinical Excellence.
    42. (2004). Free testosterone and risk for Alzheimer disease in older men.
    43. (2006). From tau to toxicity: Emerging roles of NMDA receptor in Alzheimer’s disease.
    44. (2006). Galantamine for Alzheimer’s disease and mild cognitive impairment. Cochrane Database Syst Rev,
    45. (2006). Ginkgo biloba and donepezil: a comparison in the treatment of Alzheimer’s dementia in a randomized placebo-controlled double-blind study.
    46. (2004). Ginkgo biloba compared with cholinesterase inhibitors in the treatment of dementia: a review based on meta-analyses by the Cochrane Collaboration. Dement Geriatr Cogn Disord,
    47. (2003). Ginkgo biloba extract EGb 761 in dementia: intent-to-treat analyses of a 24-week, multi-center, doubleblind, placebo-controlled, randomized trial.
    48. (2002). Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev,
    49. (2003). Ginkgo for elderly people with dementia and age-associated memory impairment: a randomized clinical trial.
    50. (2002). Hormone replacement therapy to maintain cognitive function in women with dementia. Cochrane Database Syst Rev,
    51. (2003). Idebenone treatment fails to slow cognitive decline in Alzheimer’s disease.
    52. (2006). Indirect comparisons: the mesh and mess of clinical trials.
    53. (2002). Indomethacin for the treatment of Alzheimer’s disease patients. Cochrane Database Syst Rev,
    54. (2003). Internet marketing of herbal products.
    55. (2005). Long-term cholinergic treatment is not associated with greater risk of weight loss during Alzheimer’s disease: data from the French REAL.FR cohort.
    56. (2004). Long-term donepezil treatment in 565 patients with Alzheimer’s disease (AD2000): randomised doubleblind trial.
    57. (2006). Memantine for dementia. Cochrane Database Syst Rev,
    58. (2007). Memantine in the treatment of mild-to-moderate Alzheimer’s disease. Expert Opin Pharmacother,
    59. (2006). Memantine treatment in mild to moderate Alzheimer disease: a 24-week randomized, controlled trial.
    60. (2004). Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial.
    61. (2004). Meta-analysis of randomized trials of the effi cacy and safety of donepezil, galantamine, and rivastigmine for the treatment of Alzheimer disease.
    62. (2005). Meta-analysis: highdosage vitamin E supplementation may increase all-cause mortality.
    63. (2005). Modeling the cost effectiveness of cholinesterase inhibitors in the management of mild to moderately severe Alzheimer’s disease.
    64. (2002). MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial.
    65. (2006). NICE faces legal challenge over restriction on dementia drugs.
    66. (2006). on behalf of the BAP Dementia Consensus Group Clinical practice with anti-dementia drugs: a consensus statement from British Association for Psychopharmacology.
    67. (2001). Open-label, multicenter, phase 3 extension study of the safety and effi cacy of donepezil in patients with Alzheimer’s disease.
    68. (1986). Oral tetrahydroaminoacridine in long-term treatment of senile dementia, Alzheimer type.
    69. (2006). Patterns of cholinesteraseinhibitor use in the nursing home setting: a retrospective analysis.
    70. (2002). Plasma homocysteine as a risk factor for dementia and Alzheimer’s disease.
    71. (2001). Practice parameter: management of dementia (an evidence-based review).
    72. (2002). Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial.
    73. (2002). Progress in clinical neurosciences – treatment of Alzheimer’s disease and other dementias – review and comparison of the cholinesterase inhibitors.
    74. (2006). Rationale for combination therapy with galantamine and memantine in Alzheimer’s disease.
    75. (2007). Recommendations for the diagnosis and management of Alzheimer’s disease and other disorders associated with dementia: EFNS guideline.
    76. (2005). Rivastigmine and donepezil treatment in moderate to moderately-severe Alzheimer’s disease over a 2-year period. Curr Med Res Opin,
    77. (2000). Rivastigmine for Alzheimer’s disease. Cochrane Database Syst Rev,
    78. (2006). Rivastigmine monotherapy and combination therapy with memantine in patients with moderately severe Alzheimer’s disease who failed to benefi t from previous cholinesterase inhibitor treatment.
    79. (2004). Rofecoxib: no effect on Alzheimer’s disease in a 1-year, randomized, blinded, controlled study.
    80. (2003). Signifi cance of syncope in patients with Alzheimer’s disease treated with cholinesterase inhibitors.
    81. (2004). Size of the treatment effect on cognition of cholinesterase inhibition in Alzheimer’s disease.
    82. (2005). Spontaneous bleeding associated with Ginkgo biloba – a case report and systematic review of the literature.
    83. (2003). Strategies for continued successful treatment of Alzheimer’s disease: switching cholinesterase inhibitors. Curr Med Res Opin,
    84. (2002). Switching cholinesterase inhibitor therapy in Alzheimer’s disease – donepezil to rivastigmine, is it worth it?
    85. (2002). Switching cholinesterase inhibitors in patients with Alzheimer’s disease.
    86. (2005). Switching from donepezil to galantamine: a double-blind study of two wash-out periods.
    87. (2005). Switching from donepezil to rivastigmine is well tolerated: results of an open-label safety and tolerability study.
    88. (2004). Testosterone and Alzheimer disease. Is it men’s turn now?
    89. (2003). Testosterone and dementia: too much ado about too little data.
    90. (2005). Testosterone improves spatial memory in men with Alzheimer disease and mild cognitive impairment.
    91. (2004). The benefi ts and risks associated with cholinesterase inhibitor therapy in Alzheimer’s disease. Expert Opin Drug Saf,
    92. (2003). The effect of vitamin B6 on cognition. Cochrane Database Syst Rev,
    93. (2004). The potential role of non-steroidal anti-infl ammatory drugs in treating Alzheimer’s disease. Expert Opin Investig Drugs,
    94. (2001). The recognition, assessment and management of dementing disorders: conclusions from the Canadian Consensus Conference on Dementia.
    95. (2006). Transdermal treatment options for neurological disorders: impact on the elderly. Drugs Aging,
    96. (2002). Treatment with simvastatin in normocholesterolemic patients with Alzheimer’s disease: a 26-week randomized, placebo-controlled, double-blind trial.
    97. (2003). Variations in product choices of frequently purchased herbs: caveat emptor.
    98. (2003). Vitamin B12 for cognition. Cochrane Database Syst Rev,
    99. (2007). Vitamin B6, B12, and folic acid supplementation and cognitive function: a systematic review of randomized trials.
    100. (2005). Vitamin E and donepezil for the treatment of mild cognitive impairment.
    101. (2000). Vitamin E for Alzheimer’s disease. Cochrane Database Syst Rev,

    To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.