2007 issue 1

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Volume 16, issue 1

Review article

Cholinesterase inhibitors as “vasoactive ” medications

Tomasz Sobów1, Iwona Kłoszewska1
1. Klinika Psychiatrii Wieku Podeszłego i Zaburzeń Psychotycznych Uniwersytetu Medycznego w Łodzi
Postępy Psychiatrii i Neurologii 2007; 16 (1): 75-79
Keywords: dementia, cholinesterase inhibitors, regional cerebral blood flow, central cholinergic deficit

Abstract

Objectives. Data presented in the review indicate a key role of the cholinergic system control in the cerebral blood flow regulation. Moreover, they suggest therapeutic implications of the phenomenon, including a wider spectrum of cholinesterase inhibitors (ChEIs) application in clinical practice - in addition to the central cholinergic deficit amelioration, also a vasoactive mode of their action.
Review. Despite a growing body of evidence for the presence of a central cholinergic deficit in various conditions leading to dementia, cholinesterase inhibitors are at present registered only for the treatment of mild to moderate dementia in Alzheimer's disease. The cholinergic-only hypothesis does not fully explain either the global nature of the clinical effects of ChEIs, their effects in other dementias (dementia with Lewy bodies, Parkinson's disease dementia, vascular dementia), or the strong and unpredictable interindividual variation in response to treatment. The cholinergic system disruption as well as its interaction with both amyloid $ metabolism and neurovascular regulation may shed a new light on the ChEIs impact on the cerebral blood flow regulation.
Conclusions. The common occurrence of a central cholinergic deficit in various dementias, as well as not only metabolic, but also vasoactive properties of cholinesterase inhibitors may justify their use in other than AD disorders leading to dementia.

Address for correspondence:
Dr Tomasz Sobów
Klinika Psychiatrii Wieku Podeszłego i Zaburzeń Psychotycznych Uniwersytetu Medycznego
ul. Czechosłowacka 8/10, 92-216 Łódź
e-mail: tmsobow@csk.umed.lodz.pl