Abstract
To study the impact of donepezil, rivastigmine, galantamine, and memantine on cognitive, functional, behavioral, global changes and adverse effects in patients with mild, moderate and severe Alzheimer’s disease (AD), we screened the literature published before September 2017 in the Pubmed, Embase, Cochrane library and Web of Science Electronic databases according to the inclusion criteria. Thirty-six studies were finally determined from 1560 preliminary screened articles. The AD Assessment Scale-cognitive Subscale (ADAS-cog), AD Cooperative Study-Activities of Daily Living (ADCS-ADL), Neuropsychiatric Inventory (NPI), and Clinician’s Interview-Based Impression of Change Plus Caregiver Input scale (CIBIC+) were used as valid endpoints. Of the 36 trials included, meta-analyses of these placebo-control trials showed that there were significant differences between the donepezil, rivastigmine and placebo groups using ADAS-cog, ADCS-ADL, and CIBIC+. Meta-analyses of these placebo-controlled trials showed that there were significant differences between the galantamine and placebo groups using ADAS-cog, ADCS-ADL, NPI, and CIBIC+. These observations suggest that memantine is beneficial for stabilizing or slowing the decline in ADAS-cog and ADCS-ADL19 changes in AD patients. However, there was no significant effect according to the ADCS-ADL23, NPI, and CIBIC+ tests, which indicated that memantine treatment has no significant effect on these cognitive aspects of AD patients. Different effects of donepezil, rivastigmine, galantamine, or memantine on AD were found in this study. According to the results, we conclude that galantamine is effective in treating all aspects of AD and is the first choice for the treatment of AD. However, due to limited data, we should consider additional data to obtain more stable results.
Highlights
The relationship between cognitive dysfunction or impairment and Alzheimer’s disease AD has been reported in the literature (Stern et al, 1990; Chen et al, 1998; Perry and Hodges, 2000; Caro et al, 2002; Pereira et al, 2008)
We presented a metaanalysis of the effects of donepezil, galantamine, rivastigmine, and memantine (Supplementary Table 1) on mild-to-moderate, moderate-to-severe, and severe AD using the ADAS-cog, ADCS-ADL, Neuropsychiatric Inventory (NPI) and CIBIC+ scores
There was no significant effect according to the ADCS-ADL23, NPI, and CIBIC+ tests, which indicated that memantine treatment has no significant effect on these cognitive aspects of AD patients
Summary
The relationship between cognitive dysfunction or impairment and Alzheimer’s disease AD has been reported in the literature (Stern et al, 1990; Chen et al, 1998; Perry and Hodges, 2000; Caro et al, 2002; Pereira et al, 2008). Meta-Analysis of AchE-Is in AD Therapy receptor antagonist, can normalize dysfunctional glutamatergic neurotransmission (Parsons et al, 2013), which has shown effective efficacy in the treatment of AD. Galantamine is a newly available cholinergic drug that counteracts AD by and reversibly inhibiting acetylcholinesterase (AChE) and altering the nicotinic cholinergic receptors, thereby subsequently reducing central cholinergic neurotransmission (Tariot, 2001). The deterioration of cognitive function in patients with AD appears to be mediated by the use of cholinergic drugs such as rivastigmine (Birks, 2006). Rivastigmine and galantamine, which belong to the group of ChE inhibitors (ChE-Is), are capable of cognitive, functional and behavioral improvement; none of them has been shown to be effective in the progression of AD (Zemek et al, 2014). The safety of ChE-Is and memantine has been proposed
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