Cholinesterase inhibitors, memantine and anticholinergic burden
How donepezil, rivastigmine and galantamine differ, why cholinergic effects cause bradycardia, syncope and incontinence, memantine's uncompetitive NMDA block and renal clearance, and how anticholinergic burden scales and the Drug Burden Index are calculated.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Alzheimer disease destroys cholinergic neurons in the nucleus basalis of Meynert. Cholinesterase inhibitors (ChEIs) raise synaptic acetylcholine and give a modest symptomatic benefit (about 1 to 2 MMSE points, or 2 to 3 ADAS-Cog points, over 6 months). They don't change the course.
- Memantine dampens excess glutamate signalling and is used in moderately severe disease.
- Anticholinergic drugs push the other way. They are common, cumulative and linked to delirium, falls, cognitive decline and dementia.
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Sources
- Therapeutic Guidelines: Neurology (Dementia)AU/NZTherapeutic Guidelines Ltd, 2026
- Clinical Practice Guidelines and Principles of Care for People with DementiaAU/NZNHMRC Partnership Centre for Dealing with Cognitive and Related Functional Decline in Older People (Guideline Adaptation Committee), 2016
- Australian Medicines HandbookAU/NZAustralian Medicines Handbook Pty Ltd, 2026
- Anticholinergic medication use and cognitive impairment in the older population: the Medical Research Council Cognitive Function and Ageing StudyJournal of the American Geriatrics Society (Fox C et al., 2011;59:1477-83), 2011
- Anticholinergic drug exposure and the risk of dementia: a nested case-control studyJAMA Internal Medicine (Coupland CAC et al., 2019;179:1084-93), 2019
- A drug burden index to define the functional burden of medications in older peopleAU/NZArchives of Internal Medicine (Hilmer SN et al., 2007;167:781-7), 2007
- Last updated
- 14 November 2026
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