| Summary: | Alzheimer's disease (AD), the most common adult form of dementia, is an age-associated neurodegenerative disorder pathologically characterized by the abnormal accumulation of intracellular neurofibrillary tangles and extracellular amyloid plaques in selected brain regions. Primary clinical manifestations of AD include the insidious onset and gradual progression of cognitive impairment affecting multiple domains. The two main types of AD currently recognized are a generally later-onset sporadic form, representing about 95% of all cases, and autosomal-dominant familial forms involving specific mutations in one of three genetic loci (APP, presenilin 1, and presenilin 2) and typically associated with the early-onset of AD symptoms. AD is estimated to affect 4.5 million individuals in the United States with an average course of about 8 to 10 years. The comprehensive management of AD entails both nonpharmacologic and pharmacologic interventions. Nonpharmacologic interventions primarily address behavioral disturbances and other sources of cognitive impairment. Pharmacologic strategies have focused on modulating disease-associated neurotransmitter alterations. The purpose of this review is to help policy makers and clinicians make informed choices about the use of the four ChEIs and memantine in the treatment of AD. We compare the efficacy, effectiveness, and safety (adverse events) of donepezil, galantamine, rivastigmine, tacrine, and memantine in patients with mild to severe AD.
|
|---|