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Acetylcholinesterase (ACHE) Inhibitors And Alzheimer's Disease: What Do You Need To Know?

by — Last updated: 2020-03-24 in Nervous System Disorders and Diseases

When searching for treatments for Alzheimer's Disease, many of you will come across drugs that belong in the ACHE therapy cascade. These are potentially helpful drugs that could improve the cognition and memory of a patient suffering from Alzheimer's.

Alzheimer's disease is marked by a persistent deterioration of the brain. The size, the blood supply, and the neurons are the main components of the brain that begin to decline, leading to the destruction of multiple lobes at the same time. Although this process is irreversible, some treatments can benefit patients suffering from Alzheimer's disease.

One of these would be acetylcholinesterase inhibitors. Here, we will spotlight what exactly these medications are and how they can help a patient suffering from Alzheimer's. 

What are Acetylcholinesterase Inhibitors and how do they work? 

When it comes to Alzheimer's Disease, acetylcholinesterase inhibitors are considered to be one of the first-line treatments that doctors will consider when trying to improve the quality of life of a patient afflicted with the disease.

In the brain, neurons communicate with each other by using a chemical called acetylcholine (ACh).

This is a chemical generated by the electrical current of a neuron, and when it is activated, it is able to travel to the next neuron to continue the signal. In a healthy person, this process occurs seamlessly and a signal from one region of the central nervous system to another can be transmitted in a matter of only a few milliseconds.

As the brain begins to decay with age, this signal is not able to travel as effectively and as a result, you notice the telltale signs of aging. Forgetfulness, troubles with balance, and tremors are some of the more obvious manifestations. 

As you can already see, the signs of normal aging and deficits seen from Alzheimer's disease are similar; the point at which they differ is the onset of symptoms. When it comes to a patient who is suffering from Alzheimer's disease, this signaling pathway will begin to fall apart at a much faster rate. Instead of forgetting small details, these patients can begin to notice significant gaps in their memory and ability to control the brain and central nervous system functions.

When the brain's structures begin to shrink, it can no longer efficiently produce the ACh chemical needed for intra-neuronal messaging — and the receptors responsible for catching these chemicals to process the signal are also less plentiful. Although both of these components begin to fail simultaneously, the decline in the number of receptors to catch these ACh molecules is much more significant than the reduced chemical production.

At this stage, although there no treatments can reverse the process of destruction, there are options to promote a strong signaling pathway for as long as possible. 

This is the goal of an Acetylcholinesterase inhibitor. It works by blocking an enzyme, acetylcholinesterase, from attaching to the ACh chemical and digesting it. By allowing the chemical to have more time to bind to a receptor, there is more of a chance for a message to be sent from one neuron to another and allow the body to have coordinated movements and functioning. 

Are they effective at treating Alzheimer's disease? 

Although these drugs may be considered the gold-standard therapy when it comes to Alzheimer's, the most important thing for family and friends of a loved one suffering from Alzheimer's disease to focus on is how effective they actually are. Alzheimer's features progressive degeneration, and it is important to keep in mind that this is by no means a cure. It is considered to be a treatment that will extend quality life for patients diagnosed with the disease. 

In a meta-analysis where multiple studies were investigated at the same time, it was found across many different studies that these medications are considered to be an effective agent for improving symptoms in mild to moderate forms of Alzheimer's disease. Cognitive thinking skills were especially improved. The data supporting the effectiveness of this treatment varies from study to study, but it seems that approximately 14 to 63 percent of people using these drugs can benefit when battling Alzheimer's disease. 

Alzheimer's is a cascade of multiple symptoms and deficits and can present quite differently in two similar patients. The same research determined that higher doses of the medications tend improve cognition more. This is logical because, with more of these enzyme blockers in the body, ACh will have more time to try to bind to the next neuron receptor to pass the message forward. 

A hard truth to swallow when it comes to these medications as a whole, however, is that even mild symptom improvements need to be considered temporary. A lot of relatives get false hope when they see improvements in thinking and assume that their loved one will revert back to their previous self. Unfortunately, due to the degeneration of the brain that progresses even during treatment, more and more receptors will be destroyed. Regardless of how much medication a person takes, there is no location for the chemical to bind to transmit their message. 

Although this is hard for most families and friends to cope with, remember that it is important to still be open to new therapies and treatments that could be offered. In some cases, these drugs can help improve symptoms for a number of months to even a year or two, so it is worth the gamble to see if it could be of help to someone you may know suffering from the disease. Newer medications are on the horizon that may be even more effective at helping preserve brain function, so ask your doctor to also inform you of potential clinical trials that could also help. 

  • Photo courtesy of SteadyHealth

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