Present and future of Alzheimer therapy

Three major lines of drugs have been developed or are under development for the treatment of Alzheimer Disease (AD): cholinergic drugs (mainly choline sterase inhibitors), anti-beta-amyloid drugs, estrogens and anti-inflammato ries. Cholinesterase inhibitors are the only drugs presently approved in US A and Europe for the indication of AD. Cholinesterase inhibitors tested in clinical trials in Europe, USA and Japa n include less than ten drugs, however most of these compounds have advance d to clinical trials III. Based on results related to a population of over 8,000 patients we conclude that several of these compounds have shown signi ficant clinical efficacy and safety in the treatment of Alzheimer disease. There are, however, differences with regard to side effects. The major clin ical effect is stabilization of cognitive function during a six- to 12-mont hs period with a parallel improvement of behavioral symptoms. Long-term eff ect of cholinesterase inhibitors extending to a two year-period has been re ported. Future applications of these drugs are treatment of other types dem entias such as Lewy body dementia, vascular dementia and Down Syndrome deme ntia. Combination of cholinesterase inhibitors with estrogens, anti-oxidant s and anti-inflammatories may represent a further improvement of the therap y. From the economical point of view, treatment with cholinesterase inhibit ors is not cost neutral.