Rivastigimine for Relatively Younger Alzheimer’s Disease Patient

Abstract

We presented the patient with relative younger Alzheimer's disease (AD) whose clinical symptoms and cognitive functions were responsive not to donepezil but to rivastigmine. Age of initial visit our memory clinic of this patient was relatively younger. It is considered that in relative older patient both AD pathology and aging cause cognitive dysfunctions. However, in relative younger patient not aging but only AD pathology causes cognitive dysfunctions. Therefore, AD pathology was thought to be more pronounced in our patient than relatively older patients with same cognitive disturbances. In AD, glia cells and amyloids proliferate and nervous cells shrink. Butyrylcholinesterase (BuChE) exists in glia cells and amyloids. Therefore, when AD progresses, acetylcholinesterase (AChE) decreases and BuChE increases. Accordingly the ratio of BuChE/AChE increases. Therefore, when at mild stage such our patient, not donepezil but rivastigmine which has inhibiting actions on both AChE and BuChE was suitable.

Plasma Cholinesterase Activity in Alzheimer's Disease

“…Riv is unique in its pharmacological character to inhibit not only acetylcholinesterase (AChE), but also butyrylcholinesterase (BuChE) [1]. Although we previously reported that Riv should be prescribed for relatively young patients with mild AD [2], this was not based on quantitative analysis. In this article, we propose that plasma cholinesterase activity (pChE) can be used as the standard for differentiating between the use of Riv and Don in AD patients.…”