31 Patients with this disorder appear to have a particularly profound deficit in cholinergic function and the symptoms are characterized by significant, psychiatric symptoms and behavioral disturbances. One hundred and twenty (120) patients who satisfied standard criteria for Lewy body dementia (the vast majority having fluctuating cognitive function and recurrent Inhibitors,research,lifescience,medical visual hallucinations) were recruited in the UK, Spain, and Italy (92 completed the study). Treatment started

with 1.5 mg rivastigmine or placebo twice a day, increasing by 1.5 mg twice a day, for 2 weeks until 12 mg/day or a maximum well-tolerated maintenance dosage was reached. The primary efficacy measure was a reduction in scores on the NPI. Inhibitors,research,lifescience,medical Results showed significant improvement over the course of the study, with evidence of some benefit on the global functioning. Galantamine Galantamine has a somewhat novel, dual mode of action in that, in addition to its

anticholinesterase activity, it has a modulating effect, Inhibitors,research,lifescience,medical on nicotinic acetylcholine receptors in the brain, which seem to have a role in potentiating the response to acetylcholine. In Europe and Canada, Wilcock32 PKC activity inhibition reported a 6-month study of 653 patients with mild-to-moderate Alzheimer’s disease, who were randomly assigned to either placebo or a maintenance dosage of galantamine of 24 or 32 mg/day. At. 6 months, improvements in ADL and on the CIBTC+ were recorded. Raskind et al33 reported on a 6-month, randomized, placebo-controlled trial followed by a 6-month extension. Patients with mild-to-moderate Alzheimer’s Inhibitors,research,lifescience,medical disease (n=636) were assigned to either placebo or an escalating dosage of 24 or 32 mg/day galantamine, followed by a 6-month, open-label study with 24 mg/day. The conclusion was that at 24 mg/day, the drug is effective and safe in improving cognitive function and global function (Figure 3) over 6 months, and maintaining Inhibitors,research,lifescience,medical that improvement at 12 months. A total of

978 patients were enrolled in a relatively slow escalation study described by Tariot et al.34 A 4-week, placebo run-in was concluded with patients being randomized to receive placebo or 8, 16, or 24 mg/day galantamine. After 5 months, Unoprostone those on galantamine showed improvement on the ADAS-Cog, the CIBIC+, a number of psychiatric symptoms, and ADL. Adverse events resulting in discontinuation from the trial were found in 10% of the galantamine group and 7% of the placebo group. Coylc and Kershaw35 carried out. an analysis of the extension studies of galantamine and found that patients who had been treated with 24 mg/day throughout the trials had better cognitive function compared with those on placebo. The suggestion that stabilization occurs would be in keeping with the additional nicotinic receptor modulation activity of the drug. Figure 3.