Purpose of Review: This article reviews marketed pharmacologic treatments for Alzheimer disease as well as their efficacy, effectiveness, adverse effects, and issues involved in their use, including duration of treatment, adverse events, and controversies. Current experimental drug development, including challenges to developing successful drugs for Alzheimer disease, are also reviewed and assessed.
Recent Findings: Cholinesterase inhibitors and memantine are the available pharmacologic treatment options. They show limited clinical effects over the shorter term for some patients, mild to moderate cholinergic adverse effects in a minority of patients, and potentially underappreciated toxicity over the longer term. No subsequent experimental drug in development has been successful thus far; there has not been a new drug marketed for Alzheimer disease since 2003.
Summary: Cholinesterase inhibitors and memantine are marketed for the treatment of Alzheimer disease. Drug development programs aimed at new targets, including the amyloid-β cascade, have been unsuccessful thus far despite their designs to detect very small or minimal clinical effects from the experimental drugs. Marked advances in preclinical science nevertheless support a basis for considerable optimism that effective interventions will be found soon.
Address correspondence to Dr Lon S. Schneider, Keck School of Medicine, University of Southern California, 1540 Alcazar St, CHP-216, Los Angeles, CA 90033, email@example.com.
Relationship Disclosure: Dr Schneider has served on the scientific advisory boards of or has consulted for AC Immune; Accera, Inc; Allon Therapeutics, Inc; AstraZeneca; Baxter; Biogen Idec; Biotie Therapies; California Department of Justice; Elan Corporation; Eli Lilly Corporation; EnVivo Pharmaceuticals; Hoffmann-La Roche, Inc; Janssen Pharmaceuticals, Inc; Johnson & Johnson Services, Inc; Lundbeck, Merck & Co, Inc; Phloronol, Inc; Piramal Life Sciences; Takeda Pharmaceutical Company Limited; TauRx Ltd; Toyama Chemical Company, Ltd; and Zinfandel Pharmaceuticals, Inc. Dr Schneider and the University of Southern California have received research support from Baxter; Eli Lilly Corporation; Genentech, Inc; and TauRx Therapeutics. Dr Schneider has received grants from the NIH and the State of California.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Schneider discusses the unlabeled use of donepezil, galantamine, rivastigmine, and memantine. Information on drugs is provided for general purposes only and not relied on for prescribing. Before prescribing any of the drugs discussed, the physician should be knowledgeable about the full prescribing information that can be obtained from the manufacturers.