The effect of cholinesterase inhibitors ( ChEI), the drugs currently used for treatment of Alzheimer Disease, have been considered to be mainly symptomatic and relatively short-lasting ( 6 months to one year ).More recently, several studies have demonstrated that their clinical effect on cognition can be longer than 2 years and up to 5 years .The study of Xu et al published in Neurology this march ,provides evidence that cognitive benefits may persist over 5 years with reduced mortality. The study included a matched cohort from the Swedish Dementia Registry of 11.652 users of ChEI and of 5826 nonusers during an average of 5 years follow up.The users starting on ChEI within 3 months of the diagnosis.

The use of ChEI was associated with significantly higher cognition level measured by MMSE score and a 27 % lower risk of death. Galantamine was associated with lower risk of developing severe dementia and had the strongest effect on cognitive decline of all ChEI tested . This findings are in line with results from several other clinical trials and raise the question whether or not the effect of ChEI may be not only symptomatic but also disease modifying.

Review written by Ezio Giacobini, MD, PhD

From: Long term effects of cholinesterase inhibitors on cognitive decline and mortality, Neurology, 21 April 2021