Neurology

Cholinesterase Inhibitors & Memantine song

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Cholinesterase Inhibitors & Memantine

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Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) block acetylcholinesterase, increasing synaptic ACh to compensate for cholinergic neuron loss in Alzheimer's disease.
Donepezil is used for all stages of Alzheimer's; rivastigmine is preferred in Parkinson's disease dementia and Lewy body dementia due to dual AChE and BuChE inhibition.
Cholinergic side effects of AChE inhibitors include bradycardia, nausea, vomiting, diarrhea, and increased urination — remembered by the SLUDGE/DUMBELS mnemonics.
Memantine is an NMDA receptor antagonist that blocks excessive glutamate-mediated calcium influx, which causes excitotoxic neuronal death in moderate-to-severe Alzheimer's disease.
Memantine is indicated for moderate-to-severe Alzheimer's disease and is often combined with donepezil for additive benefit via complementary mechanisms.
Unlike AChE inhibitors, memantine does not cause cholinergic side effects; its adverse effects include dizziness, confusion, and headache.
Neither AChE inhibitors nor memantine halt disease progression — they are symptomatic treatments that modestly slow cognitive decline.
Rivastigmine is available as a transdermal patch, which reduces GI side effects and improves adherence compared to oral formulations.
AChE inhibitors are contraindicated or used cautiously in patients with bradycardia, sick sinus syndrome, or active peptic ulcer disease due to cholinergic stimulation.
Galantamine has a dual mechanism: AChE inhibition plus allosteric potentiation of nicotinic ACh receptors, distinguishing it from donepezil and rivastigmine.