[Rivastigmine: a review of its clinical effectiveness]

The progression of Alzheimer s disease (AD) is linked with the appearance of symptoms in three key domains, namely activities of daily living (ADL), behaviour and cognition. The development and decline of these symptoms gives rise to a loss in the patient s functional capacity and contributes to the social, health care and economic costs associated with the disease. Tests suggest that the onset of these symptoms, in AD and in other types of dementia (e.g. frontotemporal dementia, dementia in Parkinson s disease and vascular dementia [VaD]), can be attributed to the loss of acetylcholine and cholinergic neurons in areas of the brain that are central to learning and memory, to execution functions and to behavioural and emotional responses, such as the cerebral cortex, the hippocampus and the limbic regions. There is evidence to show that the use of cholinesterase (ChE) inhibitors, including rivastigmine, donepezil and galanthamine, to enhance the survival of cholinergic neurotransmission is beneficial in the treatment of these symptoms. For example, administering rivastigmine stabilises and improves the performance of ADL in mild to moderate stages and slows down the decline in the capacity to carry out ADL in patients with serious AD. There is an improvement in the behavioural symptoms, the appearance of new symptoms diminishes and the use of other psychotropic drugs is reduced. Cognitive deficits become stable or improve during short term treatment and the treatment also delays the cognitive decline associated with the progression of the disease. A review of the available data reveals that ChE inhibition is beneficial in the long term in the three key symptomatic domains in different stages of the disease, as well as its perhaps being useful in different dementias. Therefore, it is likely that treatment with a ChE inhibitor improves quality of life and reduces the social and economic burden of these disorders