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In the UK, donepezil, galantamine and rivastigmine are licensed for symptomatic treatment of mild to moderate Alzheimer's disease, and memantine is licensed for use in moderate to severe Alzheimer's disease.1\u20134 These drugs improve cognitive function by a modest amount compared with placebo.5 Although the National Institute for Health and Care Excellence (NICE) stipulates that such treatment should be initiated by a specialist, in many parts of the UK responsibility for continued prescription of these drugs is being transferred to primary care. Here we review the evidence for drugs prescribed for cognitive symptoms in Alzheimer's disease and highlight key issues for those who are prescribing them.<\/jats:p>","DOI":"10.1136\/dtb.2014.6.0261","type":"journal-article","created":{"date-parts":[[2014,6,12]],"date-time":"2014-06-12T05:18:29Z","timestamp":1402550309000},"page":"69-72","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Prescribing drugs for Alzheimer's disease in primary care: managing cognitive symptoms"],"prefix":"10.1136","volume":"52","member":"239","published-online":{"date-parts":[[2014,6,12]]},"reference":[{"key":"2025082723493849000_52.6.69.1","unstructured":"Aricept Tablets . Summary of product characteristics, UK. Eisai Limited, January 2013."},{"key":"2025082723493849000_52.6.69.2","unstructured":"Exelon. Summary of product characteristics, EU. Novartis Europharm Limited, April 2013."},{"key":"2025082723493849000_52.6.69.3","unstructured":"Reminyl Tablets . Summary of product characteristics, UK. Shire Pharmaceuticals Limited, August 2013."},{"key":"2025082723493849000_52.6.69.4","unstructured":"Ebixa 5mg\/pump actuation oral solution, 20mg and 10mg Tablets and Treatment Initiation Pack . Summary of product characteristics, EU. H. Lundbeck A\/S, May 2012."},{"key":"2025082723493849000_52.6.69.5","unstructured":"National Institute for Health and Care Excellence, 2011. Alzheimer's disease\u00a0- donepezil, galantamine, rivastigmine and memantine (TA217) [online]. Available: http:\/\/www.nice.org.uk\/TA217 [Accessed 21 May 2014]."},{"key":"2025082723493849000_52.6.69.6","unstructured":"Alzheimer's Society, 2014. Demography [online]. Available: http:\/\/alzheimers.org.uk\/site\/scripts\/documents_info.php?documentID=412 [Accessed 21 May\u00a02014]."},{"key":"2025082723493849000_52.6.69.7","unstructured":"National Institute for Health and Care Excellence, 2006. Dementia (CG42) [online]. Available: http:\/\/www.nice.org.uk\/guidance\/CG42 [Accessed 21 May 2014]."},{"key":"2025082723493849000_52.6.69.8","doi-asserted-by":"crossref","unstructured":"Francis PT . The cholinergic hypothesis of Alzheimer's disease: a review of progress. J Neurol Neurosurg Psychiatry 1999; 66: 137\u201347.","DOI":"10.1136\/jnnp.66.2.137"},{"key":"2025082723493849000_52.6.69.9","doi-asserted-by":"crossref","unstructured":"Weinstock M . Selectivity of cholinesterase inhibition: clinical implications for the treatment of Alzheimer's disease. CNS Drugs 1999; 12: 307\u201323.","DOI":"10.2165\/00023210-199912040-00005"},{"key":"2025082723493849000_52.6.69.10","doi-asserted-by":"crossref","unstructured":"Dong XX . Molecular mechanisms of excitotoxicity and their relevance to pathogenesis of neurodegenerative diseases. Acta Pharmacol Sin 2009; 30: 379\u201387.","DOI":"10.1038\/aps.2009.24"},{"key":"2025082723493849000_52.6.69.11","doi-asserted-by":"crossref","unstructured":"Johnson JW Kotermanski SE . Mechanism of action of memantine. Curr Opin Pharmacol 2006; 6: 61\u20137.","DOI":"10.1016\/j.coph.2005.09.007"},{"key":"2025082723493849000_52.6.69.12","unstructured":"Joint Formulary Committee. British National Formulary. Edition 67. London: BMJ Group and Pharmaceutical Press, March 2014."},{"key":"2025082723493849000_52.6.69.13","doi-asserted-by":"crossref","unstructured":"Birks J Harvey RJ . Donepezil for dementia due to Alzheimer's disease. Cochrane Database Syst Rev 2006; 1: pCD001190. 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