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.