Do Acetylcholinesterase Inhibitors Have A Role In Improving Cognitive Impairment In Patients With Schizophrenia?

At present, there are no really efficacious tools available to counteract cognitive deficits in patients with schizophrenia: even though new atypical antipsychotic drugs represent an advance compared with typical antipsychotic drugs, the results obtained with this class of drugs are actually partial. Acetylcholinesterase inhibitors (AChEIs) that have been proven to be effective on psychiatric symptoms, behavioural abnormalities and cognitive dysfunction of patients with dementia may be effective on cognitive deficit in patients with schizophrenia, and may also improve their psychopathology and behaviour. In the present paper we review the use of AChEIs in the treatment of schizophrenia. Although these AChEIs have different action mechanisms (donepezil only inhibits acetylcholinesterase; rivastigmine also inhibits butyryl-cholinesterase; galantamine also interacts with nicotinic acetylcholine receptors), they have similar clinical effects. We have observed no or mild effects on cognitive deficits and symptoms in double-blind studies, a dramatic effect on a patient's subjective well-being and ability to cope and subjective judgement of psychiatrists in the case reports and open studies. The question remains as to how we can accurately measure a patient's capacity to feel, to cope and his/her desire to live with other people - aspects very different from intelligence and cognitive function. Further double-blind placebo studies are required to determine the role of AChEIs in the improvement of quality of life for patients affected by schizophreni