DRUG TREATMENT FOR THE COGNITIVE SYMPTOMS OF ALZHEIMER’S DISEASE. WHERE ARE WE NOW AND WHAT COULD BE EXPECTED IN THE NEAR FUTURE?

Abstract

The last 20-25 years 2 drug categories have been used for the treatment of cognitive symptoms in Alzheimer’s disease (AD): cholinesterase inhibitors (ChEIs), which idealy should be started at the mild stage of AD and the NMDA inhibitor memantine which is used from the moderate stage onwords. During the last years 2 modifications have been approved: (a) increase of the maximal dosage of donepezil and rivastigmine and (b) approval of combination treatment with ChEIs and memantine from the moderate stage onwards. Furthermore, expert consensus reports, incorporation in local guidelines and/or approval in the category of nutraceuticals or medical foods have occurred for gingko biloba, Fortasyn Connect and tramiprosate with the last two targeting early AD (mild cognitive impairment or early stage dementia). Given that for drug treatment no addition has occurred the last years, the decision of FDA in USA for possible approval of monoclonal antibodies (aducanumab) is expected with interest, since it may offer the first disease-modifying approach for AD.