Mental health

Role of acetylcholinesterase inhibitors

Question 1: For people with dementia, do acetylcholinesterase inhibitors, when compared to placebo/comparator, produce benefits/harm in the specified outcomes in non-specialist health settings?

  • Population: individuals with dementias, including Alzheimer’s disease, Vascular dementia, dementia with Lewy bodies
  • Interventions: acetylcholinesterase inhibitors
  • Comparison: placebo
  • Outcomes:
    • cognitive functioning
    • behavioural disturbances
    • functional status
    • mortality
    • adverse effects of interventions.


Acetylcholinesterase inhibitors should not be considered routinely for people with dementia in non-specialist health settings in low and middle income countries.
Strength of recommendation: STANDARD

Acetylcholinesterase inhibitors may be considered only in mild to moderate Alzheimer's Disease, where adequate support and supervision by specialists is available. Consideration should be given to adherence and monitoring of adverse effects, which generally requires the availability of a carer. Baseline structured cognitive and functional assessment should be carried out. Follow up should be carried out on regular basis at least every 3 months and treatment needs to be terminated in case of non-response.
Strength of recommendation: STANDARD

Evidence profile