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Review Article

Progress in mechanisms of acetylcholinesterase

inhibitors and memantine for the treatment of

Alzheimer’s disease

Shao‑Min Li , Ming‑Shu Mo , Ping‑Yi Xu 2
1
2
1 Center for Neurologic Disease, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston,
Massachusetts 02115, USA.
2 Department of Neurology, The First Affiliated Hospital of Sun Yat‑Sen University, Guangzhou 510080, Guangdong, China.

ABSTRA CT
Alzheimer’s disease (AD) is the most common causes of dementia in the elderly. Currently, only two classes of drugs,
acetylcholinesterase inhibitors (AChEIs) and memantine are approved. AChEIs ameliorate cognitive and psychiatric symptoms
in AD patients through activation of acetylcholine (ACh) receptors by increased synaptic ACh levels and also have protective
effects against glutamate neurotoxicity and inflammation, whereas memantine appears to mainly protect against excitotoxicity and
neurodegeneration. Herein, we review the pharmacologic properties of the available AChEIs and memantine, and focus on recent
progress in the mechanisms of AD in relation to acetylcholinergic and glutamatergic involvement.
Key words: Alzheimer’s disease, amyloid‑β peptide, donepezil, memantine, tau

INTRODUCTION noncompetitive antagonist of N‑methyl‑D‑aspartate
receptors (NMDAR), is indicated for patients with
As the world’s population ages and life expectancy moderate or severe AD. [1‑3]
increases, many individuals are faced with an
increased risk of developing dementia. The most Pathologically, AD is characterized by atrophy
common form of dementia is Alzheimer’s disease (AD). of the hippocampus and neocortex resulting from
About 35.6 million people worldwide are now neuronal and synaptic loss, and the deposition of two
suffering from AD, and the disease is expected to proteinaceous lesions: senile plaques containing a
affect 115 million by 2050. Although this disease core of amyloid‑beta (Aβ) peptide and neurofibrillary
[1]
has been known about for over a century, there is tangles (NFT) composed of hyperphosphorylated
no curative treatment available so far. At present, microtubule‑associated tau protein. [3,4] It is well‑accepted
four drugs have been approved by the United States that the accumulation of Aβ protein plays a central role
Food and Drug Administration for the symptomatic in the pathogenesis of AD. The severity of dementia
treatment of AD. The acetylcholinesterase (AChE) in AD correlates more strong with cortical levels of
inhibitors donepezil, rivastigmine, and galantamine soluble Aβ species than with insoluble amyloid plaque
are suggested for managing mild‑to‑moderate burden. [5,6] Experimentally, soluble Aβ oligomers have
AD, whereas donepezil and memantine, a been specifically shown to block hippocampal long‑term
potentiation (LTP), an electrophysiological correlate of
learning and memory, in vivo and in brain slices. [7‑9]
Corresponding Author: Prof. Ping‑Yi Xu,
Department of Neurology, The First Affiliated Hospital of Sun Understanding precisely how Aβ impairs hippocampal
Yat‑Sen University, No. 58, Zhongshan 2nd Road, synaptic function could enable the development of
Guangzhou 510080, Guangdong, China. potential therapeutics for AD.
E‑mail: pingyixujd@163.com
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Cite this article as: Li SM, Mo MS, Xu PY. Progress in mechanisms of
acetylcholinesterase inhibitors and memantine for the treatment of Alzheimer’s
DOI:
10.4103/2347-8659.167305 disease. Neuroimmunol Neuroinflammation 2015;2:274-80.
Received: 14-03-2015; Accepted: 29-07-2015

274 Neuroimmunol Neuroinflammation | Volume 2 | Issue 4 | October 15, 2015 Neuroimmunol Neuroinflammation | Volume 2 | Issue 4 | October 15, 2015 275