Abstract

Tetrahydroaminoacridine (THA) is a potent centrally acting anticholinesterase which has been used by anesthesiologists since the 1940s. The report by Summers et al. of encouraging results with this compound in Alzheimer''s disease was greeted with enthusiasm by both the general public and the media. Since this first publication, two relatively large clinical trials and many small-sized trials evaluating THA in Alzheimer''s disease have been published. The two larger trials had sufficient power to detect effects of the magnitude reported in the original study by Summers et al. Two conclusions can be drawn from these trials. First, THA causes substantial elevations of liver enzymes in a sizable fraction of patients. Second, the cognitive effect of THA is probably small. We conclude that, until the American multiclinical trial is completed, THA must remain a research drug used in therapeutic trials.

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