Drugs designed to improve the dementia found in Alzheimer’s sufferers have not lived up to their “billing.” By that, I mean the three cholinesterase inhibitors and the one N-methyl-D-aspartate receptor antagonist currently available have not, in my personal observation and assessment, improved the cognitive function of patients with Alzheimer’s dementia. However, because these drugs are available, we prescribe them on a trial basis only to be disappointed by assessments of progress from family and caregivers.
The cholinesterase inhibitors available are:
Razadyne (galantamine)
Aricept (donepezil)
Exelon (rivastigmine)
Cognex (tacrine). Removed from the market in 2012 because of liver toxicity.
The N-methyl-D-aspartate receptor antagonist :
Namenda (memantine)
These drugs were studied to aseeds improvements in Mini Mental Status Exam scores from baseline and after a significant trial period. The study results are below:
For Patients with Mild to Moderate dementia: donepezil or transdermal rivastigmine
worked best
For Patients with Mild to Moderate to Severe dementia: the combination of memantine
and donepezil was most effective.
Dr. G’s Opinion: These results are not consistent with real world medicine. My experience was that these drugs had little effect on dementia, and when they did help, it was short-lived and subjective. The patient improved because you wanted him to and you were generous with your assessment of his progress. Alzheimer’s Dementia has a long way to go to find a treatment that is effective long term.
Reference: AFP Clinical Answers. “What are the safest and most effective cognitive enhancers for patients with different stages of Alzheimer dementia? Am Fam Phys 2025 April;111(4):310.
My mother thought that after Reagan was diagnosed that there would be real progress in this area. She wanted help for my father. This was years ago. No progress yet. Now every time I forget something I worry. Darn.
Good assessment, Susan.