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AcetylcholineThe neurotransmitter acetylcholine (Ach) is responsible fortransmitting messages between certain nerve cells in thebrain. In AD, the plaques and tangles damage these pathways,leading to a shortage of Ach, resulting in learning and memoryimpairment.15 The loss of Ach activity correlates with theseverity of AD. The basis of pharmacologic treatment of ADhas been to improve cholinergic neurotransmission in thebrain. Acetylcholinesterase is the enzyme that degrades Achin the synaptic cleft. Blocking this enzyme leads to an increasedlevel of Ach with a goal of stabilizing neurotransmission.16 Inthe United States, the four cholinesterase inhibitorsapproved for the treatment of AD are tacrine, donepezil,rivastigmine, and galantamine.
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