The controversial promises of cholinesterase inhibitors for Alzheimer's disease and related dementias: A qualitative study of caregivers' experiences

Since their introduction, clinicians have been engaging in debates over the therapeutic benefits of cholinesterase inhibitors (ChEIs) in Alzheimer's disease and related dementias (ADRD). Against this backdrop of controversy, caregivers' views and experiences have been largely ignored. This has occurred despite the fact that this group may provide insights into these drugs in ways not captured by clinical research. To address this gap in knowledge, the current study examines 25 caregivers' narratives about the treatment of relatives diagnosed with mild to moderate ADRD and treated with ChEIs. The findings reveal an appraisal of cholinergic effects whereby caregivers question the benefits of the drugs, generally not knowing whether to attribute stabilization or improvements to them or not but also fearing termination of the drug ‘just in case’ there is some benefit. Caregivers justify their belief in ChEIs' long-term effectiveness primarily by invoking non-medicated prognostic scenarios of more rapid decline and loss of self. In addition, the study explores the meaning caregivers attribute to ChEI effects vis-à-vis a pharmaceutical discourse which frames these drugs as a source of hope.