They raise levels of a brain chemical involved in memory. They do not stop the disease, and the benefit is usually measured in months of stability rather than improvement.
Nausea and appetite loss are common side effects. Whether to continue them as dementia advances is a decision worth revisiting with the prescriber.
Why it matters
They are the drugs most families are offered first, and knowing what they can and cannot do prevents disappointment.
Questions people ask
What are cholinesterase inhibitors?
Cholinesterase inhibitors are prescription drugs that treat the memory and thinking symptoms of Alzheimer's disease. The National Institute on Aging explains that they prevent the breakdown of acetylcholine, a brain chemical believed to be important for memory and thinking. They do not cure the disease or stop it, and as Alzheimer's progresses and the brain makes less acetylcholine, these medicines lose their effectiveness over time.
What are examples of cholinesterase inhibitors?
The cholinesterase inhibitors most commonly prescribed, according to the Alzheimer's Association, are donepezil (Aricept), approved for mild to severe dementia due to Alzheimer's; galantamine (Razadyne) and benzgalantamine (Zunveyl), approved for mild to moderate Alzheimer's dementia; and rivastigmine (Exelon), approved for mild to moderate dementia due to Alzheimer's or Parkinson's disease. The person's doctor decides whether any of them fits.
What are the side effects of cholinesterase inhibitors?
Cholinesterase inhibitors are generally well tolerated, but when side effects occur the Alzheimer's Association says they commonly include nausea, vomiting, diarrhea, loss of appetite, dizziness, headache and more frequent bowel movements. The National Institute on Aging adds weight loss, muscle cramps, insomnia and fatigue for some of these drugs. Report any unusual symptoms to the prescribing doctor, and never stop a medicine without talking to them first.
Are cholinesterase inhibitors used for dementia with Lewy bodies?
Yes, they can be. The National Institute on Aging says these Alzheimer's drugs may also be used for the thinking symptoms of Lewy body dementia and may reduce hallucinations and other psychiatric symptoms. They can cause side effects such as nausea, are not always effective, and do not change behavior right away, so they are considered part of a long-term plan. A doctor familiar with Lewy body dementia should guide treatment.
Do cholinesterase inhibitors help vascular dementia?
Possibly, for some people. The National Institute on Aging says some studies suggest that medications used to treat Alzheimer's might benefit some people with an early form of vascular dementia. The main approach is different, though: vascular dementia is often managed with medications to prevent strokes and by treating high blood pressure, diabetes, high cholesterol and heart rhythm problems. Ask the doctor which approach suits the person.
Sources
Where to check this, and where to read more. All external and all authoritative.
- National Institute on Aging: How is Alzheimer's disease treated?
- US Food and Drug Administration: Alzheimer's disease
- Alzheimer's Association: Medications for memory, cognition and dementia-related behaviors
- National Institute on Aging: How is Lewy body dementia treated and managed?