Galantamine for alzheimer’s disease and alzheimer’s disease with cerebrovascular disease

Despite numerous attempts to develop new classes of compounds for either the progression or symptomatic treatment of Alzheimer’s disease, there have been no successes to date. Hence, the mainstay of the treatment of mild-to-moderate Alzheimer’s disease (AD) remains the cholinesterase inhibitors. Despite the widespread use of these drugs, there is scant literature discussing the relative differences among these compounds and the practical consequences of those differences. Indeed, a recent review in a respected journal notes that “AD… responds only marginally and briefly to currently available drugs” (Bloom 2014). The purpose of this review article is to delineate the important properties that distinguish these compounds and the clinical implications of those differences. It will do so by largely focusing on donepezil, the most frequently prescribed cholinesterase inhibitor, and contrasting donepezil with galantamine, the cholinesterase inhibitor that differs the most in its mechanism of action within this class of compounds.