Galantamine for Alzheimer's disease

Importance of the field: Alzheimer's disease (AD) is the most frequent, age-related neurodegenerative disorder and is characterized by progressive deterioration of cognition and global functioning. The relevance of the cholinergic system for memory, cognition and activities of daily life has been recognized decades ago, and research has demonstrated an early involvement and affection of central cholinergic pathways in the course of AD. Areas covered in this review: Here, we review a body of placebo-controlled studies as well as meta-analyses on the cholinesterase (ChE) inhibitor galantamine, one of only four drugs currently approved for antidementia-therapy in AD. What the reader will gain: The scope of this article is to concisely review the rationale of cholinergic treatment in AD, the chemistry and pharmacology of galantamine and to give a detailed overview of its clinical efficacy, safety, tolerability and potential usability for indications beyond AD. Take home message: Galantamine can improve and stabilize cognitive performance, activities of daily living and behavioral symptoms over the course of 6 months and its efficacy and tolerability are comparable with those of other ChE inhibitors (rivastigmine and donepezil). As long as no other drug therapies with comparable or better clinical efficacy emerge, galantamine will remain one of the standard first-line medications for mild-to-moderate AD.