A Systematic Review and Meta-Analysis of the Effectiveness of Acetylcholinesterase Inhibitors and Memantine in Treating the Cognitive Symptoms of Dementia

Dement Geriatr Cogn Disord. 2018;45(3-4):131-151. doi: 10.1159/000486546. Epub 2018 May 7.


Background: Acetylcholinesterase inhibitors (AChEIs) and memantine are commonly used in the management of dementia. In routine clinical practice, dementia is often monitored via the Mini-Mental State Examination (MMSE). We conducted a systematic review and meta-analysis of the effects of these drugs on MMSE scores.

Summary: Eighty trials were identified. Pooled effect estimates were in favour of both AChEIs and memantine at 6 months. Meta-regression indicated that dementia subtype was a moderator of AChEI treatment effect, with the effect of treatment versus control twice as high for patients with Parkinson disease dementia/ dementia with Lewy bodies (2.11 MMSE points at 6 months) as for patients with Alzheimer disease/vascular dementia (0.91 MMSE points at 6 months). Key Messages: AChEIs demonstrate a modest effect versus control on MMSE scores which is moderated by dementia subtype. For memantine the effect is smaller.

Keywords: Acetylcholinesterase inhibitor; Alzheimer disease; Memantine; Meta-analysis; Systematic review; Vascular dementia.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Alzheimer Disease / drug therapy*
  • Alzheimer Disease / psychology
  • Cholinesterase Inhibitors / pharmacology*
  • Cognition / drug effects*
  • Dementia, Vascular / drug therapy*
  • Dementia, Vascular / psychology
  • Dopamine Agents / pharmacology
  • Humans
  • Memantine / pharmacology*
  • Treatment Outcome


  • Cholinesterase Inhibitors
  • Dopamine Agents
  • Memantine