Cholinesterase Inhibitors as Adjunctive Therapy in Patients with Schizophrenia and Schizoaffective Disorder

@article{Ribeiz2010CholinesteraseIA,
  title={Cholinesterase Inhibitors as Adjunctive Therapy in Patients with Schizophrenia and Schizoaffective Disorder},
  author={Salma Rose Imanari Ribeiz and D{\'e}bora Pastore Bassitt and Jony A. Arrais and Renata Thomas {\'A}vila and David C. Steffens and C{\'a}ssio Machado Campos Bottino},
  journal={CNS Drugs},
  year={2010},
  volume={24},
  pages={303-317}
}
AbstractBackground: Cognitive deficits have been described in patients with schizophrenia from the first descriptions of dementia praecox to current concepts of cognitive dysmetria. Nevertheless, little is known about how to deal with them. In Alzheimer disease, cholinergic deficit is found and cholinesterase inhibitors have been used to delay the progression of memory and cognitive dysfunction. Several lines of evidence suggest that the cholinergic system may be disrupted in schizophrenia… 
Cholinesterase inhibitors for co-morbid Alzhemer’s disease dementia and schizophrenia: Systematic review and meta-analysis
TLDR
There is a very limited evidence on the efficacy and safety of using acetylcholinesterase inhibitors in the management of dementia co-morbid with schizophrenia and the only randomised controlled study shows lack of evidence in terms of efficacy.
Role of the cholinesterase inhibitors in the treatment of schizophrenia
  • C. Pae
  • Psychology, Medicine
    Expert opinion on investigational drugs
  • 2013
TLDR
Cholinesterase inhibitors (ChEIs) may be effective in enhancing the cognitive functioning of patients with schizophrenia and are considered potential therapeutic targets for new drugs designed to decrease cognitive deficits.
Effectiveness of rivastigmine on positive, negative, and cognitive symptoms of schizophrenia: a double-blind clinical trial
TLDR
While rivastigmine could not induce significant improvement of positive and negative symptoms of schizophrenia, it caused significant enhancement of cognitive function in this group of patients.
Effectiveness of rivastigmine on positive, negative, and cognitive symptoms of schizophrenia: a double-blind clinical trial.
TLDR
The objective of the present assessment was to evaluate the safety and clinical effects of rivastigmine, as an adjunctive drug, on the clinical symptoms of schizophrenia.
Cognitive improvement of acetylcholinesterase inhibitors in schizophrenia
TLDR
The current evidence is too weak to base recommendations on the use of acetylcholinesterase inhibitors as adjunctive treatments to antipsychotics to improve basic cognitive functions, and there is limited confidence in the effect estimates.
Cholinesterase inhibitors: beyond Alzheimer’s disease
  • A. Larner
  • Psychology, Medicine
    Expert review of neurotherapeutics
  • 2010
TLDR
Clinical practice with respect to non-Alzheimer’s disease indications for ChEIs may vary according to jurisdiction, specifically with regards to whether national guidelines effectively limit off-licence drug use.
Critics on "Adjunctive Memantine Therapy for Cognitive Impairment in Chronic Schizophrenia: A Placebo-Controlled Pilot Study"
  • C. Pae
  • Psychology, Medicine
    Psychiatry investigation
  • 2013
TLDR
This study is the first one directly digging out the possible superiority of memantine augmentation over placebo in Asian patients with chronic schizophrenia, deserving add-up of more information for future studies.
Adjunctive Memantine Therapy for Cognitive Impairment in Chronic Schizophrenia: A Placebo-Controlled Pilot Study
TLDR
Adjunctive memantine treatment did not improve cognitive functioning or affect psychopathology in patients with chronic schizophrenia in the present study, but Memantine was tolerated well and did not exacerbate positive symptoms in patientsWith chronic schizophrenia.
Rivastigmine reverses cognitive deficit and acetylcholinesterase activity induced by ketamine in an animal model of schizophrenia
TLDR
Results indicated that rivastigmine was effective to improve the cognitive deficit in different task and cholinergic system might be an important therapeutic target in the physiopathology of schizophrenia, mainly in the cognition, but additional studies should be carried.
Acetylcholinesterase Inhibitors (AChEI's) for the treatment of visual hallucinations in schizophrenia: A review of the literature
TLDR
Investigation of the evidence for the effects of AChEI's in treating visual hallucinations in Schizophrenia found no related literature in schizophrenia patients, and it is suggested that more focused research into the effects on positive symptoms of schizophrenia, specifically visual hallucinations, is needed.
...
...

References

SHOWING 1-10 OF 71 REFERENCES
Cognitive dysfunctions in schizophrenia: potential benefits of cholinesterase inhibitor adjunctive therapy.
TLDR
There is insufficient evidence on whether ChEI should be used for the treatment of cognitive dysfunctions in schizophrenia, and further studies with appropriate trial designs and outcome measures in homogenous schizophrenia populations are warranted.
Rivastigmine treatment as an add‑on to antipsychotics in patients with schizophrenia and cognitive deficits
TLDR
Rivastigmine treatment did not appear to enhance cognition in SZ patients with important cognitive impairments, and this finding needs to be interpreted with care and requires substantiation with larger sample size studies with patients treated with cognitive enhancer for longer periods.
Beneficial Effect of Donepezil Augmentation for the Management of Comorbid Schizophrenia and Dementia
TLDR
Donepezil appears to be an effective treatment for the management of symptoms of dementia accompanying patients with comorbid schizophrenia and dementia, demonstrating the possibility that this disorder may be managed with cholinergic medications as augmenting agents, at least in this specific subpopulation of patients withComorbid dementia.
Oral Cholinesterase Inhibitor Add-on Therapy for Cognitive Enhancement in Schizophrenia: A Quantitative Systematic Review, Part I
TLDR
A quantitative systematic review of the effects of AChEI on various cognitive domains (attention, language, and motor and executive functions) in schizophrenia reveals a small improvement in attention and a trend on motor tasks after A cholinesterase inhibitors medication in schizophrenia.
Add-on Therapy With Acetylcholinesterase Inhibitors for Memory Dysfunction in Schizophrenia: A Systematic Quantitative Review, Part 2
TLDR
A quantitative systematic review provides no clear evidence on whether AChEIs should be prescribed for memory enhancement in patients with schizophrenia and reveals a small to medium improvement in short- term memory and long-term memory performance.
Efficacy of cholinesterase inhibitors in the treatment of neuropsychiatric symptoms and functional impairment in Alzheimer disease: a meta-analysis.
TLDR
It is indicated that cholinesterase inhibitors have a modest beneficial impact on neuropsychiatric and functional outcomes for patients with AD and future research should focus on how such improvements translate into long-term outcomes such as patient quality of life, institutionalization, and caregiver burden.
Added donepezil for stable schizophrenia: a double-blind, placebo-controlled trial
TLDR
Adding donepezil to stable patients with schizophrenia did not improve cognition or measures of psychopathology, and this result does not support the hypothesis that residual symptoms and cognitive problems result from a cholinergic deficit that can be remedied by an acetylcholinesterase inhibitor.
Cholinergic targets for cognitive enhancement in schizophrenia: focus on cholinesterase inhibitors and muscarinic agonists
TLDR
A cholinergic approach to ameliorating the cognitive dysfunction of schizophrenia appears viable, with some preliminary data to support the efficacy of combined acetylcholinesterase inhibitors and allosteric potentiators of the nicotinic receptor.
Galantamine for the treatment of cognitive impairments in people with schizophrenia.
TLDR
Study results suggest that galantamine may have selective benefits for aspects of processing speed and verbal memory but interferes with practice effects during the performance of an attention task.
...
...