[Alzheimer drugs for mild cognitive impairment]

Improved diagnostic procedures allow to detect more patients with early stages of Alzheimer's disease (AD) within the increasing old population especially in the setting of specialised Memory Clinics. As no disease modifying or secondary preventive pharmacological treatments are presently available for AD this article discusses whether the established pharmacological treatment strategies for Alzheimer's dementia (DAT) could be beneficial as well for patients with amnestic mild cognitive impairment (MCI) that can be regarded a transitional stage between normal aging and DAT in many patients. The author does not recommend to treat MCI patients with Cholinesterase Inhibitors (ChE-I) or memantine first of all due to the general problems of a low specificity of the MCI concept and the missing data concerning the treatment of MCI patients with memantine. Moreover, ChE-I therapy in MCI showed weak beneficial effects on cognition and the delay of DAT onset whereas it is costly and has a high risk of side effects. Additionally, the pooled galantamin-data suggest an increased mortality compared to placebo. Finally, cortical cholinergic deficits and the corresponding cognitive deficits are commonly not present in MCI.