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Chapter 41. Cognitive Enhancers

Frank W. Brown, M.D.
DOI: 10.1176/appi.books.9781585623860.441242

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Excerpt

Disruption of cholinergic neurotransmission and excitatory amino acids is correlated with the development of cognitive impairment and, specifically, Alzheimer's disease (Mesulam 2004). Multiple mechanisms exist that may account for the progression of cognitive impairment, including those related to cholinesterase, N-methyl-d-aspartate, vascular disease, and oxidative damage (Aisen and Davis 1994; Bartus et al. 1982; Behl 1999; Behl et al. 1992; Jick et al. 2000; Kalaria et al. 1996; Selkoe 2000; Terry and Buccafusco 2003; Wolozin et al. 2000). An outcome of the disruption of many neurotransmitter systems, cognitive impairment may occur at any time during the disease process as synaptic plasticity becomes impaired, degrading the efficiency of neuronal transmission (Malik et al. 2007). It is intuitive that the earliest intervention prior to irreversible disease progression is optimal. Currently, it is unknown when the irreversible disease processes begin; no specific markers have been identified that could guide clinicians to initiate prophylactic treatment prior to the development of cognitive or behavioral manifestations.

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Table Reference Number
TABLE 41–1. Recommended cholinesterase inhibitors

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CME Activity

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Sample questions:
1.
Of the acetylcholinesterase inhibitors (AChEIs) that have been marketed in the United States, which of the following is no longer recommended for clinical use?
2.
Which of the following acetylcholinesterase inhibitors (AChEIs) has been postulated to be of greater benefit in the treatment of Alzheimer’s disease because it increases butyrylcholinesterase (BChE) in the hippocampus and cortex while decreasing acetylcholinesterase (AChE) activity?
3.
Which of the following acetylcholinesterase inhibitors (AChEIs) is unique in that it also modulates neuronal nicotinic receptors?
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