Donepezil in more advanced Alzheimer's disease

Donepezil is currently approved for treatment of patients with mild to moderate Alzheimer's disease (AD). However, since cholinergic activity declines as AD progresses, increasing acetylcholine levels would be expected to provide benefits in severe AD. The primary objective of this article is to review the recent data demonstrating that patients with advanced AD can benefit from treatment with the cholinesterase inhibitor donepezil.

A MEDLINE (PubMed) literature search was performed using the key words "donepezil" and "advanced AD."

The search yielded 13 articles, which were then further screened for the criterion: randomized, double-blind, placebo-controlled clinical study.

Two studies were found that met these specific study criteria. In the first study, donepezil-treated patients with moderate to severe AD showed significant improvements in cognition and behavior, with preservation of activities of daily living compared with placebo-treated patients. Similar improvements in donepezil-treated patients were seen in the second study involving 27 nursing homes. In this study of older patients, donepezil treatment significantly improved cognition, function, and agitated and aggressive behaviors. Safety and tolerability findings of these two studies are further assessed. Considerations for drug therapy as well as a case study are presented to illustrate the benefits of donepezil treatment in patients with advanced AD.

. The decision to continue treating severe AD patients with donepezil is an opportunity for consultant pharmacists to decrease the burden of caregivers and to maximize a patient's quality of life for as long as possible.