Efficacy of Cholinesterase Inhibitors in Vascular Dementia: An Updated Meta-Analysis

Abstract

Background/Aims: The objective of this study was to determine whether treatment with acetylcholinesterase inhibitors would provide cognitive benefit for patients with vascular dementia. Methods: Studies in patients with vascular dementia, who had not taken acetylcholinesterase inhibitors or memantine for at least 6 weeks, were included. Results: Twelve studies were included in the final analysis. Donepezil showed significant improvement in Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) as compared to placebo, at the doses tested, that is, 5 and 10 mg/day (difference in means -1.389 and -1.680, respectively, p ≤ 0.008), but not on the Mini Mental State Examination (MMSE) (p ≥ 0.259). Galantamine also improved the ADAS-cog in comparison to the placebo (difference in means -2.191, p < 0.001), whereas, rivastigmine did not show any benefit on ADAS-cog. However, the findings with rivastigmine are difficult to interpret, given there were only 2 studies. Treatment with cholinesterase inhibitors was associated with a twofold increase in the odds of discontinuation, due to adverse events (pooled OR 1.966, 95% CI 1.630-2.371, p < 0.001). Conclusion: The present results reveal the therapeutic benefits of donepezil and galantamine in patients with vascular dementia. Interestingly, the ADAS-cog and MMSE varied considerably in detecting cognitive improvement.

Practical algorithms for managing patients with cognitive impairments

“…При недостаточной эффективности выбранного ингибитора ацетилхолинергического препарата целесообразно поменять его на другой препарат из той же фармакологи-ческой группы. Базисную терапию начинают либо с мемантина, либо с ингибитора ацетилхолинэстеразы, а через некоторое время (обычно через 1-2 года) при снижении эффективности монотерапии переходят на комбинированную терапию (мемантин + ингибитор ацетилхолинэстеразы) [37][38][39][40].…”

Design, Synthesis and Biological Assessment of Novel 2‐(4‐Alkoxybenzylidine)‐2,3‐dihydro‐5,6‐dimethoxy‐1H‐inden‐1‐one Derivatives as hAChE and hBuChE Enzyme Inhibitors

“…AChE efficiently catalyzes the acetylcholine hydrolysis . Some of the well‐known cholinesterase inhibitors are donepezil, galantamine, and rivastigmine (Figure1) . Among them, donepezil was introduced as a reversible inhibitor of AChE in the USA for treatment of mild, moderate, and severe AD .…”

An Overview of Systematic Reviews of Ginkgo biloba Extracts for Mild Cognitive Impairment and Dementia

“…Up to now, no disease-modifying therapy has been available (Kennedy and Sud, 2014). Cholinesterase inhibitors increase the concentration of neurotransmitter in the brain and improve memory (Rockwood et al, 2013; Yáñez and Viña, 2013; Chen et al, 2016); NMDA receptor antagonists reduce neurotoxicity through inhibiting excitatory amino acid receptors (Newport et al, 2015; Schmidt et al, 2015); other drugs such as Serotonergic agents, Dopamine blocking agents, Benzodiazepines alleviate specific other symptoms (Schneider et al, 2014; Deardorff et al, 2015). Thus, there are multiple alternative strategies with moderate efficacy for some patients for a limited amount of time.…”