Role of Cholinesterase Inhibitors in Managing Behavioral Problems in Alzheimer's Disease.

Alzheimer's disease is characterized by pro- gressive cognitive and functional decline and the emergence of behavioral disturbances. Behavioral symptoms, in particular, cause great distress to caregivers, creating an emotional and financial burden that often prompts the caregiver to place the patient in a nursing facility. The clinical de- terioration in Alzheimer's disease is, in part, a result of deficits involving several neurochemical pathways. The cholinergic system, which is the most consistently and dramatically affected neu- rotransmitter system in Alzheimer's disease, has been strongly implicated in the emergence of neu- ropsychiatric symptoms. This article reviews evi- dence suggesting that, in addition to effects on cognition and function, the cholinesterase inhibi- tors benefit the behavioral symptoms of Alzhei- mer's disease. Pharmacologic and nonpharmaco- logic treatment strategies for the management of behavioral symptoms are discussed.