Differential effects of acetylcholinesterase inhibitors on clinical responses and cerebral blood flow changes in patients with Alzheimer's disease: a 12-month, randomized, and open-label trial

Soichiro Shimizu; Hidekazu Kanetaka; Daisuke Hirose; Hirohumi Sakurai; Haruo Hanyu

doi:10.1159/000375527

Differential effects of acetylcholinesterase inhibitors on clinical responses and cerebral blood flow changes in patients with Alzheimer's disease: a 12-month, randomized, and open-label trial

Dement Geriatr Cogn Dis Extra. 2015 Apr 10;5(1):135-46. doi: 10.1159/000375527. eCollection 2015 Jan-Apr.

Authors

Soichiro Shimizu¹, Hidekazu Kanetaka¹, Daisuke Hirose¹, Hirohumi Sakurai¹, Haruo Hanyu¹

Affiliation

¹ Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan.

Abstract

Background/aims: The present study evaluated the differences in treatment outcomes and brain perfusion changes among 3 types of acetylcholinesterase inhibitors (AchEIs, i.e. donepezil, rivastigmine, and galantamine).

Methods: This was a prospective, longitudinal, randomized, open-label, 3-arm (donepezil, rivastigmine, or galantamine), parallel-group, 12-month clinical trial carried out in 55 patients with AD.

Results: At 6 months, the results of the Mini-Mental State Examination (MMSE) and the Trail Making Test (TMT)-Part A showed an improvement versus baseline in the donepezil treatment group. All groups showed a significant increase in regional cerebral blood flow (rCBF), mainly in the frontal lobe. Significant rCBF reduction was observed in the temporal lobe and cingulate gyrus in all 3 groups.

Conclusion: AchEI treatment prevents the progression of cognitive impairment and increases the relative rCBF in the frontal lobe.

Keywords: Acetylcholinesterase inhibitors; Alzheimer's disease; Donepezil; Galantamine; Regional cerebral blood flow; Rivastigmine; Single-photon emission computed tomography.