, Volume 61, Issue 1, pp 41–52 | Cite as

Cholinesterase Inhibitors for Alzheimer’s Disease

  • Jaime Grutzendler
  • John C. Morris
Review Article


Alzheimer’s disease (AD) is the most common age-related neurodegenerative disease and has become an urgent public health problem in most areas of the world. Substantial progress has been made in understanding the basic neurobiology of AD and, as a result, new drugs for its treatment have become available. Cholinesterase inhibitors (ChEIs), which increase the availability of acetylcholine in central synapses, have become the main approach to symptomatic treatment. ChEIs that have been approved or submitted to the US Food and Drug Administration (FDA) include tacrine, donepezil, metrifonate, rivastigmine and galantamine. In this review we discuss their pharmacology, clinical experience to date with their use and their potential benefits or disadvantages. ChEIs have a significant, although modest, effect on the cognitive status of patients with AD. In addition to their effect on cognition, ChEIs have a positive effect on mood and behaviour. Uncertainty remains about the duration of the benefit because few studies of these compounds beyond one year have been published. Although ChEIs are generally well tolerated, all patients should be followed closely for possible adverse effects. There is no substantial difference in the effectivenes of the various ChEIs, however, they may have different safety profiles. We believe the benefits of their use outweigh the risks and costs and, therefore, ChEIs should be considered as primary therapy for patients with mild to moderate AD.


Rivastigmine Tacrine High Dose Group Galantamine Physostigmine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Supported by National Institute on Aging grants AG03991 and AG05681 and by National Institute of Neurological Disorders and Stroke grant NS34050.


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Copyright information

© Adis International Limited 2001

Authors and Affiliations

  1. 1.Alzheimer Disease Research Center and Department of NeurologyWashington University School of MedicineSt LouisUSA

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