Poster
181
(#181) Acetylcholinesterase inhibitors effects on behaviors in Alzheimer's Disease: A Review
Psych Congress 2025
Abstract: Alzheimer's Disease is characterized by the degeneration of cholinergic neurons and reduced synaptic acetylcholine. Acetylcholinesterase inhibitors (AChEIs) offer a symptomatic treatment option. Related aberrant motor behavior, agitation, delusions, and other behavioral symptoms contribute to caregiver burden and earlier institutionalization. Persistent AChEI use may stabilize behavioral symptoms and delay initiation of psychotropic medications, a significant concern in long-term care.
A literature review was conducted to evaluate the impact of AChEI on the Neuropsychiatric Inventory (NPI). The NPI assesses the frequency and severity of symptoms in 10 or 12 domains, plus caregiver's distress.
A meta-analysis pooled NPI data from three galantamine studies, nine donepezil studies and one rivastigmine study. Galantamine showed significant reductions in NPI scores compared to placebo. No significant effect was observed for donepezil or rivastigmine. Three Cochrane Systematic Reviews support these findings. A large 5-month placebo-controlled trial demonstrated galantamine improved behavioral symptom scores, with statistically significant differences observed in total NPI scores at 16 and 24 mg/day doses. A prospective study of patients switched from donepezil to galantamine showed that patients exhibited statistically significant improvements in NPI scores for delusions, agitation, and aberrant motor behavior three months post-switch.
Benzgalantamine/galantamine's behavioral benefits may be due to its unique dual mechanism of action: AChEI and positive allosteric modulation of nicotinic cholinergic receptors. By increasing acetylcholine and enhancing nicotinic receptor activity, benzgalantamine/galantamine was shown to significantly improve several NPI domains including aberrant motor behavior, agitation, anxiety, apathy, delusions, disinhibition, and hallucinations.
Short Description: This review reminds clinicians of the benefits of AChEIs above those directly associated with cognitive stabilization. It explores the impact of AChEIs on behavioral symptoms, focusing on improvements on total Neuropsychiatric Inventory (NPI) scores as well as related sub-domains. Available evidence indicates galantamine, unlike donepezil or rivastigmine, significantly reduces total NPI scores and several NPI sub-domains. Galantamine's unique dual mechanism-AChEI and positive allosteric modulation of nicotinic receptors may contribute to these effects.
Name of Sponsoring Organization(s): N/a
A literature review was conducted to evaluate the impact of AChEI on the Neuropsychiatric Inventory (NPI). The NPI assesses the frequency and severity of symptoms in 10 or 12 domains, plus caregiver's distress.
A meta-analysis pooled NPI data from three galantamine studies, nine donepezil studies and one rivastigmine study. Galantamine showed significant reductions in NPI scores compared to placebo. No significant effect was observed for donepezil or rivastigmine. Three Cochrane Systematic Reviews support these findings. A large 5-month placebo-controlled trial demonstrated galantamine improved behavioral symptom scores, with statistically significant differences observed in total NPI scores at 16 and 24 mg/day doses. A prospective study of patients switched from donepezil to galantamine showed that patients exhibited statistically significant improvements in NPI scores for delusions, agitation, and aberrant motor behavior three months post-switch.
Benzgalantamine/galantamine's behavioral benefits may be due to its unique dual mechanism of action: AChEI and positive allosteric modulation of nicotinic cholinergic receptors. By increasing acetylcholine and enhancing nicotinic receptor activity, benzgalantamine/galantamine was shown to significantly improve several NPI domains including aberrant motor behavior, agitation, anxiety, apathy, delusions, disinhibition, and hallucinations.
Short Description: This review reminds clinicians of the benefits of AChEIs above those directly associated with cognitive stabilization. It explores the impact of AChEIs on behavioral symptoms, focusing on improvements on total Neuropsychiatric Inventory (NPI) scores as well as related sub-domains. Available evidence indicates galantamine, unlike donepezil or rivastigmine, significantly reduces total NPI scores and several NPI sub-domains. Galantamine's unique dual mechanism-AChEI and positive allosteric modulation of nicotinic receptors may contribute to these effects.
Name of Sponsoring Organization(s): N/a
