Cholinesterase inhibitors in the clinical management of Alzheimer's disease: importance of early and persistent treatment.

Alzheimer's disease is a neurodegenerative disease that greatly affects the quality of life of patients and their caregivers and places a heavy cost burden on the healthcare system. The cholinesterase inhibitors (ChEIs) donepezil, rivastigmine and galantamine have a central role in the treatment of Alzheimer's disease in the mild to moderate stages. Clinical trials with ChEIs have demonstrated therapeutic benefits for symptoms of cognition, function and behaviour across the disease course. These agents are most effective when started early in the disease course and used persistently, without treatment gaps. Early recognition of Alzheimer's disease and a global evaluation of treatment effectiveness are therefore essential. This article identifies barriers to early recognition and effective care of patients with Alzheimer's disease and discusses practical strategies to overcome them.