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Evidence for Psychotropic Effects of Acetylcholinesterase Inhibitors

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Abstract

Alzheimer’s disease is a dementing illness, the risk of which increases markedly with age. It is estimated that it consumes $US90 billion annually. Alzheimer’s disease is marked by an expanding cholinergic deficit, with a direct relationship between the degree of cholinergic dysfunction and the cognitive impairment. Substantial research continues to be focused on the development of newer and better medications, in particular acetylcholinesterase inhibitors (AChEIs), to compensate for the cholinergic deficit.

Trial observations over the past several years suggest that in addition to positive effects on cognitive function, AChEIs may be able to decrease and ameliorate the neuropsychiatric symptoms frequently associated with Alzheimer’s disease. These observations have also shown that the instrumentation used can significantly influence the interpretation and outcome of a study. Typically the individual subscores of the noncognitive component of the Alzheimer’s Disease Assessment Scale (ADAS-noncog) and the Neuropsychiatric Inventory (NPI) scale have most consistently reflected the ability of AChEIs to improve the noncognitive behavioural problems and neuropsychiatric symptoms.

Apathy and visual hallucinations are the symptoms that respond most positively to AChEIs. These agents may have the potential to decrease polypharmacy in this elderly population by achieving symptom reduction without additional use of antipsychotic medication.

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Acknowledgements

This project was supported by a National Institute on Aging Alzheimer’s Disease Research Center grant (AG 16570), an Alzheimer’s Disease Research Center of California grant, and the Sidell-Kagan Foundation. Dr Cummings has served as a consultant or performed research in conjunction with Novartis, Parke-Davis, Pfizer/Eisai, Bayer, Lilly, Janssen and Smith-Kline Beecham regarding agents relevant to this article.

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Authors and Affiliations

  1. Department of Neurology, School of Medicine, University of California, Los Angeles, California, USA

    Jeffrey L. Cummings & Sylvia Askin-Edgar

  2. Psychiatry & Biobehavioral Sciences, School of Medicine, University of California, Los Angeles, California, USA

    Jeffrey L. Cummings

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  1. Jeffrey L. Cummings
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  2. Sylvia Askin-Edgar
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Correspondence to Jeffrey L. Cummings.

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Cummings, J.L., Askin-Edgar, S. Evidence for Psychotropic Effects of Acetylcholinesterase Inhibitors. Mol Diag Ther 13, 385–395 (2000). https://doi.org/10.2165/00023210-200013060-00001

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