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To the Editor: In their meta-analysis, Dr Trinh and colleagues¹ found that cholinesterase inhibitors (ChIs) had beneficial effects on neuropsychiatric symptoms in patients with Alzheimer disease (AD). The overall effect size was small but statistically significant and consistent across studies. This conclusion, however, may have limited value for predicting treatment effects for individual patients in clinical practice. Several lines of evidence suggest that AD is a heterogenous disease² and that the relative efficacy of ChIs varies widely among patients.³ Moreover, this class of drugs may be also effective for patients with other neuropsychiatric syndromes.⁴

This raises the question of the mechanism of the effect of ChIs. We have suggested that patients with specific impairments of attention and concentration, anxiety, restlessness, and hallucinations respond well to ChIs.⁴ This central cholinergic deficiency syndrome may occur in various neurodegenerative conditions such as AD, Lewy body dementia, and Parkinson disease, but is not necessarily . . . [Full Text of this Article]

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