Acetylcholinesterase inhibitors slow down the action of cholinesterase, an enzyme involved in neural processes in the brain. They are used to stabilize dementia in Alzheimer’s patients and reverse drug-induced paralysis during surgery. Side effects include stomach upset and headache. They work best in the early stages of Alzheimer’s and patients should be evaluated regularly for improvement and side effects.
Acetylcholinesterase inhibitors, also known as anticholinesterases, are drugs that slow down the action of cholinesterase or acetylcholinesterase. This is an enzyme involved in neural processes in the brain. Cholinesterase converts acetylcholine into choline and acetic acid in a brain process in which cholinergic neurons transition from an active state to a resting state.
Low acetylcholinesterase levels are associated with Alzheimer’s disease, and acetylcholinesterase inhibitors have been shown to stabilize dementia in Alzheimer’s patients. They work by increasing the availability of cholinesterase to the brain. Acetylcholinesterase inhibitors are also used to reverse drug-induced paralysis during surgery and in the treatment of myasthenia gravis and glaucoma. Although not yet approved by the American Food and Drug Administration (FDA), acetylcholinesterase inhibitors have been evaluated for use in the diagnosis of vascular dementia, dementia with Lewy bodies, and Parkinson-induced dementia. This type of drug is also used in pesticides and biochemical warfare.
Side effects of acetylcholinesterase inhibitors include stomach upset, diarrhea, sweating, slow heart rate, and headache. Usually, these side effects are minor and seem to go away within a few days of starting the drug. The drug is a neurotoxin and high doses can be fatal, so close patient monitoring is required.
Research suggests that acetylcholinesterase inhibitors work best when prescribed for the early stages of Alzheimer’s, and while not a cure, they may prolong the time between the onset of Alzheimer’s and the need for institutionalization. This allows Alzheimer’s patients more time at home with loved ones and also saves money by reducing the need for full-time care by improving behavior and thinking ability. Trials are still ongoing to evaluate the effect on patients with advanced Alzheimer’s.
It is recommended that the patient taking acetylcholinesterase inhibitors be evaluated four to six weeks after starting treatment to evaluate the improvement of symptoms and to monitor for side effects. Thereafter they should be evaluated every three months. Clinical data suggest that treatment with this drug is less effective after one year, and drug therapy is usually stopped at this time, although some patients continue to show improvement. Patients typically need to be evaluated on a case-by-case basis to determine if this therapy is right for them.
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