Question: In people with moderate (including mild-moderate and moderate-severe) dementia how effective are cholinesterase inhibitors when compared to memantine in reducing cognitive or functional decline?


The available evidence suggests that both the acetylcholinesterase inhibitor donepezil and memantine can offer statistically significant cognitive and functional benefits, which are sustained over one year, and that donepezil can offer clinically significant cognitive benefits. However, there was no evidence for a statistically significant difference in treatment effect (on any outcome measure) between the two treatments. All data were derived from patients with Alzheimer's Disease and studies comparing one acetylcholinesterase inhibitor (donepezil) with memantine; findings may not be generalisable to patients with other types of dementia or to treatment with other acetylcholinesterase inhibitors. Further, adequately powered, RCTs are needed to adequately assess the comparative effectiveness of acetylcholinesterase inhibitors and memantine in reducing cognitive and functional decline in patients with dementia.