Pharmacological Treatment of Alzheimer’s Disease in Early Stages: A Literature Review

Abstract

Background: Alzheimer’s disease (AD) is a progressive neurodegenerative disorder and the leading cause of dementia worldwide. As the global population ages, early diagnosis and treatment have become increasingly important. While symptomatic pharmacological therapies are widely used, novel disease-modifying drugs have emerged in recent years, with uncertain clinical efficacy.

Objective: This thesis aimed to review and evaluate the efficacy and safety of available pharmacological treatments for patients with early-stage Alzheimer’s disease.

Methods: A systematic literature search was conducted in PubMed on 3 September, 2023, yielding 3,005 articles. After applying strict eligibility criteria, 13 studies were included. Data were extracted and evaluated both individually and thematically. The quality of evidence was assessed using the GRADE framework for each included article.

Results: Cholinesterase inhibitors, particularly donepezil, demonstrated consistent symptomatic benefits in cognitive outcomes and remain the most evidence-based treatment for early-stage AD. In contrast, disease-modifying therapies such as aducanumab, donanemab, and lecanemab showed significant reductions in amyloid burden. However, their clinical effects were variable and associated adverse events – especially amyloid-related imaging abnormalities (ARIA) – raised safety concerns. Among the disease-modifying agents, lecanemab showed the most consistent clinical benefit.

Conclusion: Symptomatic treatment with cholinesterase inhibitors remains the cornerstone of pharmacological management in early-stage Alzheimer’s disease. Although recent disease-modifying agents demonstrate promising biomarker effects, their inconsistent clinical efficacy and safety profiles currently limit their use in clinical care. Further research is needed to clarify long-term outcomes, explore multimodal approaches, and develop biomarker-driven strategies for individualised treatment.