Donepezil, galantamine and rivastigmine (the acetylcholinesterase - AChE - inhibitors) can now be used in mild disease, as well as in moderate disease. These drugs all work by increasing the level of ACh at sites of neurotransmission.
Memantine can be used in moderate disease if patients can't take AChE inhibitors. It can also be used in severe disease. Memantine is a (wait for it!) voltage-dependent, moderate-affinity, uncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist. Basically, there are increased levels of glutamate seen at neurotransmitter sites. Memantine blocks the effects of this increased glutamate.
@NASGP designation as specialist initiation for mild dementia seems unhelpful. Missed opportunity for GP diagnosis.
— Shelagh McCormick (@ShelaghMcC) June 29, 2016
Conditions for use
- Specialist use only
- They should only be continued of there is improvement in cognition or global, functional or behavioural symptoms.
- For AChE inhibitors, taking into account individual needs, the lowest acquisition drug should be used.