Cholinesterase Inhibitors and Beyond
Abstract
Cholinesterase inhibitors (ChEIs) were introduced in the therapy of Alzheimer Disease (AD) in the nineteen nineties with great expectations. The hopes and large interest raised by these drugs are well demonstrated by 12,000 references listed by PubMed under 'ChEI' for 1995-2007. The list is reduced to 2500 if we confine ourselves to 'ChEIs and dementia'. Of them, about 500 were published in the last two years. Whereas an increase in brain acetylcholine and an improvement of cognitive deficits have been consistently demonstrated in animal models of AD, from aging rats to transgenic mice, the clinical effectiveness of ChEIs has been and is still a matter of contrasting opinions. These range from the negative conclusions of the AD2000 trial on donepezil, claiming that it is not cost effective, with benefits below a minimally relevant threshold, to the NICE appraisal of 2007 declaring that donepezil, rivastigmine, galantamine are efficacious for mild to moderate AD, irrespective of their different selectivity for acetyl- (AChE) and butyrylcholinesterase (BuChE). The possibility that ChEIs may exert their effects through mechanisms beyond cholinesterase inhibition has been envisaged. However, according to the information presented in this review, the "classical" ChEIs, donepezil, rivastigmine and galantamine, show no pharmacological actions beyond cholinesterase inhibition which may play an important role in their therapeutic efficacy. The diverging opinions on clinical efficacy do not discourage from developing new ChEIs, and particularly the so called multifunctional ChEIs. They represent the future of the cholinergic therapy for AD but other indications for these drugs may be considered, including vascular dementia, mild cognitive impairment, and the ethically sensitive improvement of memory and learning in healthy subjects.
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The limited therapeutic, pro-cognitive efficacy of AChE inhibitors appears to be an expected finding when considering that inhibition of AChE is not capable of restoring or augmenting the phasic glutamatergic-cholinergic interactions which mediate defined cognitive operations.
“The limited therapeutic, pro-cognitive efficacy of AChE inhibitors (e.g., Pepeu and Giovannini, 2009) appears to be an expected finding when considering that inhibition of AChE is not capable of restoring or augmenting the phasic glutamatergic-cholinergic interactions which, as will be described below, mediate defined cognitive operations (see also Sarter and Bruno, 2002; Sarter et al, 2007).”
From Modes and models of forebrain cholinergic neuromodulation of cognition (2011) · cites this paper as Pepeu and Giovannini, 2009
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- Authors
- Pepeu, G., & Giovannini, M.
- Affiliations
- University of Florence (IT)
- Corresponding author
- Giovannini, Maria
- ORCID
- Giovannini, Maria
- Venue
- Current Alzheimer Research
- Publisher
- Bentham Science Publishers Ltd.
- Published
- 2009-04-01
- Volume
- 6
- Issue
- 2
- Pages
- 86-96
- ISSN
- 1567-2050 (ISSN-L)
- OpenAlex
- W2133779850
- Cited by
- 209
- References
- 96
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 9 · 2023: 7 · 2022: 10 · 2021: 1 · 2020: 12 · 2019: 13 · 2018: 8 · 2017: 8 · 2016: 15 · 2015: 19 · 2014: 22 · 2013: 12 · 2012: 19
- FWCI
- 15.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Alzheimer Research (publishedVersion)
- PubMed (publishedVersion)
- Florence Research (University of Florence) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Cholinesterase and Neurodegenerative Diseases
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- cholinesterase inhibitors, Alzheimer's disease, donepezil, rivastigmine, galantamine, acetylcholinesterase, butyrylcholinesterase, cholinergic therapy, vascular dementia, mild cognitive impairment, memory enhancement, clinical efficacy
- MeSH terms
- Acetylcholine, Alzheimer Disease, Animals, Brain, Cholinesterase Inhibitors, Cholinesterases, Clinical Trials as Topic, Cognition Disorders, Humans, Antipsychotic Agents, History, 20th Century, History, 21st Century
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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