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Role of Cholinesterase Inhibitors inManaging Behavioral Problems in Alzheimer's Disease

Donna L. Masterman, M.D.

Alzheimer's disease is characterized by progressive cognitive and functional decline and the emergence of behavioral disturbances. Behavioral symptoms, in particular, cause great distress to caregivers, creating an emotional and financial burden that often prompts the caregiver to place the patient in a nursing facility. The clinical deterioration in Alzheimer's disease is, in part, a result of deficits involving several neurochemical pathways. The cholinergic system, which is the most consistently and dramatically affected neurotransmitter system in Alzheimer's disease, has been strongly implicated in the emergence of neuropsychiatric symptoms. This article reviews evidence suggesting that, in addition to effects on cognition and function, the cholinesterase inhibitors benefit the behavioral symptoms of Alzheimer's disease. Pharmacologic and nonpharmacologic treatment strategies for the management of behavioral symptoms are discussed.

(Prim Care Companion J Clin Psychiatry 2004;6:126-131)

Received July 30, 2003; accepted March 18, 2004. From the UCLA Department of Neurology, Los Angeles, Calif.

Supported by funding from Pfizer Inc, New York, N.Y., and Eisai Inc., Teaneck, N.J.

Dr. Masterman serves as a consultant to Pfizer, Eisai, Novartis, Janssen, AstraZeneca, and Eli Lilly; has received grant/research support from Pfizer and Eisai; has received honoraria from Pfizer, Eisai, Novartis, Janssen, Forest, and AstraZeneca; and serves on the speakers or advisory boards for Pfizer, Eisai, Novartis, Janssen, and AstraZeneca.

Corresponding author and reprints: Donna L. Masterman, M.D., One Amgen Center Drive, Thousand Oaks, CA 91320-1799(e-mail: