Cited by 231Cholinesterase and Neurodegenerative DiseasesAlzheimer's disease research and treatmentsDementia and Cognitive Impairment Research

Cholinesterase Inhibitors and Beyond

Pepeu, Giancarlo, Giovannini, Maria·2009·Current Alzheimer Research

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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Crossref · 10.2174/156720509787602861

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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
Venue
Current Alzheimer Research
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

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