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Donepezil in patients with severe Alzheimer's disease: double-blind, parallel-group, placebo-controlled study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
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2006 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 367, no 9516, 1057-1065 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The cholinesterase inhibitor donepezil is used to treat mild-to-moderate Alzheimer's disease. Its efficacy in severe dementia has not been assessed and is controversial. Our aim was to ascertain the effectiveness of donepezil in patients with severe Alzheimer's disease, by focusing primarily on cognition and activities of daily living. METHODS: We did a 6-month, double-blind, parallel-group, placebo-controlled study in 248 patients with severe Alzheimer's disease (mini mental state examination score 1-10) who were living in assisted care nursing homes ran by trained staff in Sweden. We assigned patients oral donepezil (5 mg per day for 30 days then up to 10 mg per day thereafter, n=128) or matched placebo (n=120). Our primary endpoints were change from baseline to month 6 in the severe impairment battery (SIB) and modified Alzheimer's Disease Cooperative Study activities of daily living inventory for severe Alzheimer's disease (ADCS-ADL-severe). We analysed outcomes for patients with data at baseline and at one or more other timepoints (modified intent-to-treat population) with last observation carried forward used to replace missing data. FINDINGS: 95 patients assigned donepezil and 99 patients assigned placebo completed the study. Patients treated with donepezil improved more in SIB scores and declined less in ADCS-ADL-severe scores at 6 months after initiation of treatment compared with baseline than did controls (least squares [LS] mean difference, 5.7, 95% CI 1.5-9.8; p=0.008, and 1.7, 0.2-3.2; p=0.03, respectively). The incidence of adverse events was comparable between groups (donepezil 82% [n=105] vs placebo 76% [n=91]), with most being transient and mild or moderate in severity. More patients discontinued treatment because of adverse events in the donepezil group (n=20) than in the placebo group (n=8). INTERPRETATION: Donepezil improves cognition and preserves function in individuals with severe Alzheimer's disease who live in nursing homes.

Place, publisher, year, edition, pages
2006. Vol. 367, no 9516, 1057-1065 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-103512DOI: 10.1016/S0140-6736(06)68350-5ISI: 000236673200029PubMedID: 16581404OAI: oai:DiVA.org:uu-103512DiVA: diva2:218364
Group Author(s): Severe Alzheimers Disease Study GroupAvailable from: 2009-05-19 Created: 2009-05-19 Last updated: 2010-10-20Bibliographically approved

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