Long-term Efficacy and Safety of Donepezil Dose Escalation for Patients with Alzheimer?s Disease in a Clinical Setting

Author Info

Laura Tan Chathuri J Yatawara Debby Ng Nagaendran Kandiah

Corresponding Author

Nagaendran Kandiah
Department of Neurology, National Neuroscience Institute, Singapore, Singapore

A B S T R A C T

Background: Donepezil is a routinely prescribed cognitive enhancer for patients with Alzheimer’s disease (AD), however the effectiveness and safety of long-term high doses remains largely unexplored. Objective: We investigated the long-term efficacy and safety of Donepezil dose escalation in reducing global cognitive decline for patients with AD in a clinical setting. Method: In a naturalistic, open-label, controlled study design, 71 mild to moderate AD patients from a tertiary clinic were prescribed Donepezil 5mg/day for 12 months (phase 1), while 9 AD patients received no treatment. Patients who showed limited benefits (N=30) with Donepezil 5mg/day were titrated up to 10mg/day for a subsequent 12 months (phase 2) and the remaining (N=41) patients continued on 5mg/day. The primary outcome was global cognition, indexed using the Mini-Mental State Examination (MMSE). Results: Phase 1 trends confirmed Donepezil 5mg/day was better than no treatment at reducing cognitive decline (p = .09, f=.18). Phase 2 trends indicated that for patients who showed limited response to Donepezil 5mg/day, Donepezil 10mg/day was more effective in reducing slope of cognitive decline (p = 0.13, f= .42). Additionally, the patients that were titrated up to 10mg/day had comparable treatment benefits to those patients that remained on 5mg/day during phase 2 (p = .32, f =.12). Side effects in the 10mg/day group were not significantly different from the side effects in the 5mg group (t (67)=-1.27, p=.21). Conclusion: Donepezil dose escalation in patients with AD is safe and may result in large noticeable effects on cognition, with effects comparable to patients who initially responded well to 5mg/day.

Article Info

Article Type

Research Article

Publication history

Received: Sat 28, Apr 2018
Accepted: Wed 09, May 2018
Published: Fri 08, Jun 2018

Copyright

© 2023 Nagaendran Kandiah. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.NNB.2018.10.004