Podcast: Does galantamine help people with dementia due to Alzheimer's disease and people with mild cognitive impairment?

There are many Cochrane Reviews of possible treatments for dementia. One of the earliest of these looked at the effects of a drug called galantamine, which is found in daffodil bulbs, and the review was updated in November 2024.

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Mike: Hello, I’m Mike Clarke, podcast editor for the Cochrane Library. There are many Cochrane Reviews of possible treatments for dementia. One of the earliest of these looked at the effects of a drug called galantamine, which is found in daffodil bulbs, and the review was updated in November 2024.

The review focuses on Alzheimer’s disease, which is the most common type of dementia. It causes progressive decline in cognition function, daily living activities, and behaviour. However, for people with mild cognitive impairment, characterised by cognitive deficits that do not typically disrupt daily life, there are currently no medications approved for treatment.
Galantamine is approved for managing symptoms in people who have been diagnosed with Alzheimer’s disease. It works by increasing the levels of acetylcholine in the brain, a neurotransmitter crucial for cognitive processes. While there is no cure for Alzheimer’s disease, galantamine can help slow the progression of symptoms.
The latest version of this Cochrane review brings in research published up to December 2022, with an emphasis on the effects on cognitive function, global clinical status, activities of daily living, behavioural symptoms, and adverse effects.
The review now includes 21 randomised trials, involving nearly 11,000 participants. Most trials lasted six months, but this update has been able to bring in the data from a two-year trial, providing insights into the long-term effects of galantamine.
Turning to the results, galantamine demonstrated clear benefits for people with mild to moderate Alzheimer’s disease. After six months of treatment, participants receiving galantamine showed improvements in cognitive function, the ability to perform daily activities, and behavioural symptoms compared to those on placebo. There was also a reduced mortality risk within six months, compared to placebo. However, gastrointestinal side effects, particularly nausea, were common and led many people to stop taking galantamine. The findings from the two-year trial corroborated the benefits, highlighting sustained improvements in cognition and function, and a lower mortality risk.
For people with mild cognitive impairment, galantamine showed little to no benefit on cognitive function or daily activities. However, it likely reduced the risk of progression to dementia over two years. This is important, particularly for people at this early stage of cognitive decline. Nevertheless, the potential benefit must be weighed against the increased likelihood of gastrointestinal side effects and the associated higher rates of treatment discontinuation.
In conclusion, galantamine demonstrated benefits for cognitive, functional, and behavioural outcomes in people with Alzheimer’s disease over both the short and long term, despite common gastrointestinal side effects. For people with mild cognitive impairment, although galantamine does not appear to improve cognitive or functional outcomes, it may reduce the risk of progression to dementia.
Therefore, this updated review highlights that galantamine remains a valuable treatment option for Alzheimer’s disease, although its use in mild cognitive impairment should be approached with caution, balancing potential benefits against adverse effects.

If you would like to learn more about the effects of galantamine, you can find the full review online. It’s at CochraneLibrary.com and you’ll see a link with a simple search for “galantamine”.

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