Aricept actually treats Alzheimer's disease, not just symptoms?

In Beating the Dementia Monster we repeated the conventional wisdom around the cholinesterase inhibitors, that they may temporarily improve cognition among those with Alzheimer's disease, but you're still dead on the same day.  They treat the symptoms, not the disease.  But maybe that's not true.  The problem with that statement is that there was very little research in which people were followed for an extended period of time to see if the drugs might actually do more than address symptoms. 

There are three cholinesterase inhibitors, galantamine (Razadyne, etc.), donepezil (Aricept, etc.) and rivastigmine (Exelon, etc.).  They have been around since the 1990s and have been widely used.  I tried donepezil for a short time in 2015 when I was first diagnosed, but I found that it made me sick.  So I quit using it, going on to rely on lifestyle changes to treat my disease.  But maybe I should give it another shot.

There is excitement around a new Swedish study published in the journal Neurology, "Long-term Effects of Cholinesterase Inhibitors on Cognitive Decline and Mortality."  The study results were summarized in this press release.   The study investigated long-term effects of the three cholinesterase inhibitors on cognitive decline, development of severe dementia, and on mortality.  (Alzheimer's is a deadly disease.)  The study population was patients with Alzheimer’s dementia or mixed Alzheimer’s dementia.  The researchers used data from the Swedish Dementia Registry.  

The study included 11,652 cholinesterase inhibitor users and 5,826 non-users.  They had a mean age of 81.2, and 62% were female.  The researchers evaluated cognitive function using the Mini-Mental Status Examination (MMSE).  Scores lower than 10, on a scale from 0 to 30, indicates severe dementia, while scores between 21 and 24 indicate mild dementia. 

At the start of the study, the mean MMSE score was 21.2 for all patients, 22 for cholinesterase inhibitor users, and 21.9 for non-users.  During the average five-year follow-up period, cholinesterase inhibitor users were found to have better MMSE scores at any visit compared with non-users.  Those taking one of the drugs had some slowing of decline, but I didn't find the numbers impressive.  Of the three, galantamine (Razadyne) had the strongest effect on cognition.  Also, it was the only one that had the ability to decrease the risk of developing severe dementia.  

Thirty-five per cent of the patients died during the five-year follow up period, however mortality among users of cholinesterase inhibitors was 27% lower than the control.  Razadyne users had a 29% decrease in mortality, Aricept users had a 22% reduction in mortality, and Exelon users had only a 14% reduction.  I guess the takeaway is that, taken over a period of time, cholinesterase inhibitors substantially improve cognition and extend the lives of Alzheimer's patients.  And Razadyne seems to do both best. 

So this has me thinking that I need to look into this again.  I will be in Seattle for my annual cognitive tests in a week, and I will see my neurologist two weeks after that.  This will be on the agenda.