Clinical question
How effective is donepezil in people with mild, moderate and severe dementia due to Alzheimer disease (AD)?
Bottom line
There is moderate‐quality evidence that people with mild, moderate or severe dementia due to AD treated for periods of 12 or 24 weeks with donepezil experience small benefits in cognitive function, activities of daily living and clinician‐rated global clinical state. There is no evidence of a difference between donepezil and placebo for patient total healthcare resource utilisation. Benefits on donepezil 23mg/day are no greater than with 10mg/day, and benefits on the 10mg/day dose are marginally greater than on the 5mg/day dose, but the rates of withdrawal and of adverse events before the end of treatment are higher with the higher doses.
Caveat
Most studies were of 6 months' duration or less. Only one small trial lasted 52 weeks. There does not appear to be any effect of donepezil on quality of life. Seventeen of the 28 studies were industry funded or sponsored.
Context
AD is the most common cause of dementia in older people. One approach to symptomatic treatment of AD is to enhance cholinergic neurotransmission in the brain by blocking the action of the enzyme responsible for the breakdown of the neurotransmitter acetylcholine. This can be done by drugs known as cholinesterase inhibitors, such as donepezil.
Cochrane Systematic Review
Birks JS and Harvey RJ. Donepezil for dementia due to Alzheimer’s disease. Cochrane Reviews, 2018, Issue 6. Art. No.: CD001190.DOI: 10.1002/14651858. CD001190.pub3. This review contains 30 studies involving 8257 participants.
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