Cholinesterase inhibitors are a group of drugs recommended for the treatment of Alzheimer’s disease, but their effects on cognition have been discussed, and few studies have investigated their long-term effects. A new study involving researchers from the Karolinska Institutet in Sweden and published in the journal Neurology shows lasting cognitive benefits and reduced mortality up to five years after diagnosis.
Alzheimer’s disease is a cognitive brain disease that affects millions of patients around the world. Approximately 100,000 people in Sweden live with the diagnosis, which has a profound impact on the lives of them and their families. Most of those diagnosed are over 65, but there are some patients who are diagnosed in their 50s.
The current cost of care and treatment for people with dementia in Sweden is approximately SEK 60 billion per year. This equates to the cost of caring for and treating cardiovascular disease and is twice the cost of treating cancer.
In Alzheimer’s disease, there are changes in several chemical neurotransmitters in the brain, and thus in the ability of neurons to communicate with each other. Acetylcholine is one such substance and plays a key role in cognitive functions such as memory, attention and concentration.
There are three drugs that act as cholinesterase inhibitors and are used to treat Alzheimer’s disease: galantamine, donepezil and rivastigmine.
However, the effects of cholinesterase inhibitors have been discussed, in part because there are relatively few longitudinal clinical studies. Researchers from the Karolinska Institutet and Umeå University have now conducted a registration study of patients with Alzheimer’s disease over five years from the time of diagnosis.
The study is based on data from SveDem (Swedish Dementia Registry) on 11,652 patients treated with cholinesterase inhibitors and a corresponding control group of 5,826 untreated patients.
The results showed that treatment with cholinesterase inhibitors was associated with a slower decline in cognitive abilities over five years and 27 percent lower mortality in patients with Alzheimer’s disease compared with controls.
Of the three drugs, galantamine had the strongest effect on cognition, which could be due to its effect on nicotinic receptors and its inhibitory action on the enzyme acetylcholinesterase, which degrades the neurotransmitter acetylcholine. “
Hong Xu, first author of the study, postdoctoral researcher, Department of Neurobiology, Nursing and Society, Karolinska Institutet
“Our results provide strong support for current recommendations for treating people with Alzheimer’s disease with cholinesterase inhibitors, but also show that the therapeutic effect lasts a long time,” says study author and initiator Maria Eriksdotter, a professor in the Department of Neurobiology. Science of Nursing and Society, Karolinska Institutet.
Xu, H., and others. (2021) Long-term effects of cholinesterase inhibitors on cognitive decline and mortality. Neurology. doi.org/10.1212/WNL.0000000000011832.