While everyone is eagerly awaiting a magic bullet for Alzheimer’s disease, some drugs already on the market may actually combat Alzheimer’s more than many people realize, experts at the World Alzheimer Congress 2000 suggested.

For instance, it is pretty clear that the cholinesterase inhibitors can improve cognition in persons with mild to moderate Alzheimer’s. But how helpful are they, really? This is a controversial area, said Rachelle Doody, M.D., Ph.D., of Baylor College of Medicine, Houston, since the magnitude of benefits, the consistency of response across subjects, and the duration of benefits have all been questioned and are under study.

Nonetheless, she would personally argue that not just persons with mild to moderate Alzheimer’s, but individuals with advanced Alzheimer’s as well, might benefit from the cholinesterase inhibitors. One of the reasons, she said, is because of a Canadian study. When patients severely impaired by Alzheimer’s were given donepezil, they did better than comparable patients given a placebo.

Ezio Giacobini, M.D., Ph.D., of the University of Geneva went further: He suspects that the cholinesterase inhibitors are not only countering symptoms interfering with cognition, but are altering the Alzheimer’s disease process to some extent. The reason, he explained, is that studies conducted by his group, and some others, have shown that patients with mild to moderately severe Alzheimer’s placed on cholinesterase inhibitors stabilized in the course of their disease for one or two years. "One year seems to be well established," he said.

How might the cholinesterase inhibitors affect the Alzheimer’s disease process? Perhaps by influencing the production of beta amyloid, the stuff from which Alzheimer’s plaques are made, he conjectured. The cholinesterase inhibitors might not just influence acetycholine levels in the brain, but also impact the regulation of amyloid precursor protein—the protein in the brain from which beta amyloid derives, new data suggest.

The cholinesterase inhibitors may be able to blunt a spate of neuropsychiatric disturbances provoked by Alzheimer’s, according to Jeffrey Cummings, M.D., of the University of California at Los Angeles. A reduction in apathy and visual hallucinations has been reported most frequently, although a diminution in anxiety, depression, delusions, agitation, and aberrant motor behavior also has been noted in some patients.

Moreover, other drugs on the market besides the cholinesterase inhibitors may be able to calm the neuropsychiatric turbulence of Alzheimer’s, he pointed out. For instance, a recent trial demonstrated that the atypical antipsychotic risperidone reduced psychosis and aggression in patients with Alzheimer’s. Another demonstrated the same for olanzapine. The agitation of Alzheimer’s has been countered by atypical antipsychotics, conventional neuroleptics, antiepileptic drugs, and trazodone.