Cholinesterase inhibitors for the treatment of Alzheimer's disease in the elderly

The treatment of Alzheimer's disease is of increasing importance as the pop ulation ages and the number of people with the disease increases. The aetio logy of Alzheimer's disease is complex and therefore treatment strategies r ely on generalised pathological findings. Cholinesterase inhibitors enhance a generalised deficit of central nervous system acetylcholine and are the first class of agents specifically approved for the treatment of Alzheimer' s disease. The clinical efficacy of the different cholinesterase inhibitors is similar ; however, differences in pharmacodynamic and pharmacokinetic parameters ca n influence tolerability and safety in the elderly population. Concomitant disease states, significant drug interactions and the altered kinetics and dynamics seen in elderly patients call also affect treatment outcome. Although cholinesterase inhibitors are not 'curative' for Alzheimer's disea se, clinical evidence indicates that these drugs can significantly delay th e progress of cognitive impairment. Consequently, they represent a useful t reatment for the symptoms of Alzheimer's disease in the elderly.