1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Donepezil for Vascular Dementia

Cholinesterase inhibitors might help some patients with vascular dementia, but improvement was modest in this trial.

Cholinergic drugs for dementia are approved for use in patients with Alzheimer's disease but haven't been studied thoroughly in patients with vascular dementia. In this multicenter, international, industry-sponsored trial, researchers examined the efficacy of the cholinesterase inhibitor donepezil (Aricept) in 616 patients who met criteria for probable or possible vascular dementia. Two thirds of the patients had suffered previous clinical strokes, and 76% had cerebral infarctions on imaging studies.

Patients were randomized to donepezil (5 mg or 10 mg daily) or placebo and were followed for 24 weeks. On the ADAS-cog (a 70-point scale that measures cognitive function, with 0 being a perfect score and 70 indicating profound dementia), baseline scores were about 20. Scores improved by an average of 2 to 3 points in the donepezil groups and by about 1 point in the placebo group -- a significant difference. A global assessment instrument (derived from interviews with patients and caregivers) indicated clinical improvement in 25% of placebo recipients, 32% of patients who received 10-mg donepezil, and 39% of those who received 5-mg donepezil. Adverse events that were associated with donepezil included diarrhea, nausea, insomnia, and leg cramps; gastrointestinal side effects tended to be dose-related.

Comment: These results suggest that donepezil has some efficacy in patients with vascular dementia, but the benefits were modest compared with placebo effects. Cholinesterase inhibitors could have a role in selected patients with vascular dementia, but they are unlikely to yield clinically noticeable changes in most patients.

— Allan S. Brett, MD

Published in Journal Watch General Medicine September 26, 2003

Citation(s):

Wilkinson D et al. Donepezil in vascular dementia: A randomized, placebo-controlled study. Neurology 2003 Aug 26; 61:479-86.

• Original article (Subscription may be required)
• Medline abstract (Free)