Question: In adults with Alzheimer’s Disease or mixed dementia, which is the most effective Acetylcholinesterase Inhibitor in ameliorating symptoms or slowing deterioration in memory/cognition?

Answer:

No definite clinical implications can be made from the available evidence. In order to best address the above question, head-to-head trials of acetylcholinesterase inhibitors are required, yet very few
good quality head-to-head studies have been conducted (as reported by one well-conducted systematic review). Based on pairwise comparisons, there is some evidence to suggest that donepezil, rivastigmine and galantamine are all significantly more effective than placebo for
cognitive outcomes.

The authors of a SR suggested that more good quality RCTs of long-term duration are required, and that trials should aim to use the same standardised outcomes measures. In addition, they stated that more research into valid ways of accounting for missing data are needed in studies that measure degenerative diseases such as AD.