Clinical Question Is donepezil ef...

Clinical Question

Is donepezil effective in the treatment of vascular dementia?

Evidence-Based Answer

Donepezil in a dosage of 10 mg daily provides a small benefit in patients with mild to moderate vascular dementia and generally is well tolerated.

Practice Pointers

Donepezil, a cholinesterase inhibitor, is somewhat effective in the treatment of mild to moderate cognitive impairment caused through Alzheimer's disease. Malouf and Birks examined the evidence from sum of two units similar manufacturer-sponsored studies of donepezil in a total of 1219 patients with vascular cognitive impairment (sometimes called "multi-infarct dementia" or "vascular dementia"). the couple studies were randomized, double blinded, and placebo controlled

Validated diagnostic criteria were used to identify patients with probable vascular dementia. Given the challenge of diagnosing dementia subtype before death, however, a substantial number of patients probably had mixed vascular and Alzheimer's dementia. (1)

Patients who took donepezil performed slightly better forward tests of cognitive function, as it is as the Mini-Mental State Examination (weighted mean difference, 12 points at 24 weeks upon this 30-point scale) and the Alzheimer's Disease Assessment Scale cognitive subscale. Patients who took the 10-mg dosage did better than those who took the 5-mg dosage. Patients who took the 10-mg dosage (but not the 5-mg dosage) also did better than ascendency patients on the Clinical Dementia Rating scale. There was no difference between arranges on the Alzheimer's Disease Functional Assessment and Change Scale, which focuses onward activities of daily living. Compared with the lower dosage and placebo, the 10-mg dosage was associated with more adverse circumstances (odds ratio for at least united adverse event, 1.95; 95 percent confidence interval, 120 to 315; P = 007) greatest in quantity adverse events were minor, and the pond ed dropout rate and the rate of sharp adverse events were similar between groups

REFERENCE

(1) Hogervorst E Bandelow s Combrinck M, Irani S, Smith AD. The validity and reliability of 6 appoints of clinical criteria to classify Alzheimer's disease and vascular dementia in cases confirmed post-mortem: added value of a decision tree approach. Dement Geriatr Cogn Disord 2003;16:170-80

MARK H EBELL, MD M Malouf R Birks J Donepezil for vascular cognitive impairment. Cochrane Database Syst Rev 2004;(3):CD004395

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