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Donepezil effectively improves cognitive function and daily living activities in patients with vascular cognitive impairment. This cholinesterase inhibitor is well-tolerated, with most side effects being transient.

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Area of Science:

  • Neurology
  • Pharmacology
  • Geriatrics

Background:

  • Vascular dementia is a leading cause of cognitive impairment, second only to Alzheimer's disease.
  • Challenges exist in classifying vascular cognitive impairment due to varied presentations and overlapping neuropathology with Alzheimer's.
  • Cholinergic neurotransmission deficiency, common in Alzheimer's, is implicated in vascular dementia, suggesting cholinesterase inhibitors like donepezil as potential treatments.

Purpose of the Study:

  • To evaluate the clinical effectiveness and tolerability of donepezil in individuals with vascular cognitive impairment.
  • To assess donepezil's impact on cognitive function, global impression, daily activities, and social functioning.

Main Methods:

  • Systematic review of randomized, double-blind, placebo-controlled trials comparing donepezil with placebo.
  • Inclusion criteria focused on unconfounded trials, excluding combination therapies.
  • Data extraction and analysis involved pooling results and calculating weighted mean differences or odds ratios.

Main Results:

  • Two large trials included 1219 patients with mild to moderate vascular dementia.
  • Donepezil (5 or 10 mg daily) significantly improved cognitive function (ADAS-Cog, MMSE) and global impression (CDR-SB) compared to placebo over 24 weeks.
  • Benefits in activities of daily living (ADFACS) were observed, though not consistently across all scales or doses. Donepezil was generally well-tolerated, with transient side effects like nausea and diarrhea more frequent at the 10 mg dose.

Conclusions:

  • Donepezil demonstrates efficacy in enhancing cognitive function, global impression, and daily living activities in patients with mild to moderate vascular cognitive impairment after 6 months.
  • Further research is needed to establish long-term efficacy and benefits in advanced stages of cognitive impairment.
  • Development of specific diagnostic criteria and rating scales for vascular cognitive impairment is urgently required.