Maintaining functional and behavioral abilities in Alzheimer disease

Limitations associated with conventional acetylcholinesterase inhibitors have led to interest in therapies with more than one mode of action. Galantamine is a novel treatment for Alzheimer disease with a dual mode of action. The mechanisms involved may result in better long-term cognitive function, and may specifically affect behavioral symptoms. Three acetylcholinesterase inhibitors available in the USA, donepezil, rivastigmine and tacrine, have demonstrated improvements in activities of daily living. However, data are mixed and much is questionable because of the outcome measures used. Galantamine showed evidence of functional benefit in three pivotal Phase III studies of up to 6 months' duration. Furthermore, galantamine stabilized instrumental and basic activities of daily living in an open-label 12-month study. This long-term maintenance of functional ability would be expected to be an important benefit for patients and carers. Open-label studies have suggested that donepezil and tacrine might have beneficial effects on behavioral symptoms. In a 5-month pivotal study, galantamine significantly slowed the progression of behavioral symptoms in patients with mild-to-moderate Alzheimer disease. These behavioral benefits were associated with reduced caregiver distress and translated into reduced caregiver time. These benefits would be expected to make an important difference to the quality of life of patients and caregivers.