Photo Credit: libre de droit

The following is a summary of “Efficacy of acetylcholinesterase inhibitors on reducing hippocampal atrophy rate: a systematic review and meta-analysis,” published in the February 2025 issue of BMC Neurology by Ismail et al. 

Neurodegenerative diseases (NDs) cause progressive nerve tissue degeneration, leading to cognitive and functional decline. Acetylcholinesterase inhibitors (AChEIs) help manage symptoms, but their effect on hippocampal atrophy remains unclear. 

Researchers conducted a retrospective study to assess the efficacy of AChEIs in reducing hippocampal atrophy in NDs. 

They systematically searched PubMed, Scopus, Web of Science, and Cochrane databases until August 20, 2024, for randomized controlled trials (RCTs) and comparative studies on hippocampal volume changes in elderly patients with NDs. They used a random effect model to estimate pooled atrophy rates and conducted subgroup analysis based on disease, dosage, and measurement. 

The results showed that out of 5,943 screened studies, 9 were included in the review and 6 in the meta-analysis, with 2,179 participants. Donepezil 10 mg significantly reduced hippocampal atrophy (SMD = 0.44, 95% CI [0.08 to 0.81], P = 0.01), while 5 mg showed no effect. Pooled results favored donepezil (SMD = 0.33, P = 0.04), with higher doses being more effective. In MCI, donepezil and vitamin E reduced hippocampal atrophy (SMD = 0.27, P = 0.01). Galantamine showed no effect on hippocampal atrophy but reduced whole-brain atrophy in APOE ε4 carriers. No significant difference was found between right and left hippocampal atrophy in donepezil-treated patients. 

Investigators found that donepezil 10 mg reduced hippocampal atrophy in Alzheimer’s disease and mild cognitive impairment, while 5 mg and galantamine showed no effect. Galantamine reduced whole brain atrophy in APOE ε4 carriers, highlighting the role of dosage and genetics in treatment efficacy. 

Source: bmcneurol.biomedcentral.com/articles/10.1186/s12883-024-03933-4