CLINICAL QUESTION

Is galantamine effective in treating patients with Alzheimer disease and mild cognitive impairment?

EVIDENCE-BASED ANSWER

In people with mild to moderate Alzheimer disease, treatment with galantamine, 8 to 12 mg twice daily, slows the decline in cognitive function, behavioral function, and functional disability at 6 months compared with placebo.¹ Galantamine also slows the decline in global function at 6 months. However, it leads to more all-cause discontinuation of pharmacotherapy and more nausea.

For people with mild cognitive impairment, galantamine is responsible for more all-cause discontinuation of pharmacotherapy, nausea, and death compared with placebo.¹ (Strength of Recommendation: A, consistent, good quality, patient-oriented evidence.)

PRACTICE POINTERS

Approximately 6.9 million people older than 65 years in the United States are living with dementia, and this number will increase as the population ages.² Alzheimer disease is the most common form of dementia among older people. The disease progresses over time and impairs people's cognitive and behavioral functions and activities of daily living. People with mild cognitive impairment have milder symptoms than those with dementia, and they typically do not interfere with daily activities. Cholinesterase inhibitors, including donepezil (Aricept), galantamine, and rivastigmine, as well as the N-methyl-d-aspartate receptor antagonist, memantine, are thought to slow the decline of cognitive function in dementia.^3,4 No drugs are currently approved to treat mild cognitive impairment. The authors of this Cochrane review sought to assess the effectiveness of galantamine in treating the symptoms of Alzheimer disease and mild cognitive impairment.¹