Long-term benefits of galantamine (Reminyl) in Alzheimer’s disease

The natural history of Alzheimer’s disease, combined with recognition of the advantages of introducing specific treatment early in the course of the disease, means that patients may take medication for several years. Previous studies of galantamine (Reminyl) have shown an excellent record of safety and efficacy over 12 months with a broad spectrum of benefits that includes functional and behavioural aspects as well as cognition. Results from an open-label study extension now indicate that continuous treatment with galantamine is associated with cognitive benefits for at least 36 months. The benefits were equivalent to slowing the progress of Alzheimer’s disease by 12–18 months. Alzheimer’s disease (AD) is a chronic neurological condition with an inexorable, progressive course. As the disease progresses, patients become increasingly dependent on others for all aspects of daily life and towards the end of their lives many require full-time care in an institution. Apart from amyloid plaques and neurofibrillary tangles, one of the core pathological features of AD is the loss of neurons, including cholinergic neurons, and reduced cholinergic neurotransmission. The most effective treatment option developed to date consists of enhancing transmission at the cholinergic nerve endings by the use of acetylcholinesterase inhibitors. Of the currently available agents, galantamine (Reminyl) is unique in having a dual mode of action, comprising not only competitive inhibition of acetylcholinesterase, but also allosteric nicotinic receptor modulation that increases the response to acetylcholine within the synaptic cleft. Expectations of early treatment in AD In the early stages of AD, the cognitive deficit is relatively mild and disturbances of behaviour and functional ability may be slight. Early treatment offers the greatest opportunities for preserving cognitive and functional ability and prolonging patient autonomy, and for reducing the overall level of patient and caregiver distress. Galantamine has a broad spectrum of action, and an improvement in any clinically relevant area (e.g. cognition, functional ability, behaviour, and demands on caregivers) should be considered a response to treatment. Patients with AD may survive for up to 8 years after the diagnosis of AD. Any interventions intended to slow or halt the progress of the disease will be needed over a long period, and the earlier treatment is introduced, the longer Joint Statistical Meetings Section on Statistical Graphics