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Psychiatrist.comCholinesterase Inhibitors for Delusions and Hallucinations in Alzheimer Disease and Parkinson Disease: Questionably Significant Benefits

Cholinesterase Inhibitors Show Limited Effectiveness in Treating Psychotic Symptoms in Dementia

The increasing prevalence of dementia worldwide has led to a rise in associated psychotic symptoms, including delusions and hallucinations. A recent meta-analysis examined the potential of cholinesterase inhibitors (ChEIs) in treating these symptoms in Alzheimer’s disease (AD) and Parkinson’s disease (PD), revealing significant but clinically insignificant effects.

Key Points:

  • A meta-analysis found ChEIs to reduce the severity of delusions and hallucinations in AD and PD.
  • Effect sizes were small, ranging from −0.08 to −0.14, and considered clinically insignificant.
  • No drugs have been specifically approved for psychotic symptoms in dementia, except pimavanserin in PD.

Additional Points:

  • Antipsychotic drugs, while effective, carry risks of serious adverse events, including mortality.
  • Many unknowns remain in ChEIs treatment, such as optimal dosing, time to improvement, and chances of symptom remission.
  • In May 2023, the FDA approved brexpiprazole for treating agitation in Alzheimer’s disease.


  • ChEIs show some promise in reducing psychotic symptoms in dementia, but the effects are minimal and further research is needed to identify more effective treatments.

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Did You Know?
The global prevalence of dementia is expected to rise from 57.4 million cases in 2019 to a staggering 152.8 million cases in 2050.

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