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There is no evidence to support the use of donepezil for patients with mild cognitive impairment (MCI). The putative benefits are minor, short lived and associated with significant side effects

Problems with memory which do not meet the diagnostic criteria for dementia, usually called mild cognitive impairment (MCI), can be the first sign of an impending dementia, particularly Alzheimer's disease, but are not necessarily so. Some memory problems are temporary and some do not worsen. Treatment in the very earliest stages of AD may delay progression to AD. Donepezil (Aricept, E2020), a cholinesterase inhibitor, has been shown to benefit all severities of AD including mild and it is reasonable to investigate its efficacy for those with MCI. There is little evidence that donepezil improved cognitive function, and no evidence that donepezil delays progression to AD, but it was associated with significant side effects. There is no evidence to support the use of donepezil for patients with MCI.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Donepezil for dementia in people with Down Syndrome

Donepezil is a drug which is thought to discourage the breakdown of acetylcholine, which is a neurotransmitter in the brain that is important to how memory functions. Acetylcholine is lacking in people with Alzheimer's disease (AD). The drug donepezil has been reported to have benefits for people with mild to moderate Alzheimer's disease who do not have Down syndrome. However, people with DS tend to present with AD at a much younger age than the general population as well as being physically different in terms of size, metabolism and heart rate, and may therefore have different requirements.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Evidence of efficacy of donepezil for people with mild or moderate vascular cognitive impairment

Acetylcholine is a neurotransmitter involved in memory function. Acetylcholinesterase inhibitors, such as donepezil, inhibit the breakdown of acetylcholine and have been shown to be of benefit for people with mild to moderate Alzheimer's disease. Deficits in acetylcholine mediated neurotransmission have been postulated in cognitive impairment due to vascular disease of the brain. Two large‐scales randomized trials provide evidence of beneficial effects from donepezil at doses of 5 or 10 mg per day over 24 weeks. The drug was well tolerated and drop‐out rate was low.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Cholinesterase inhibitors (ChEIs), donepezil, galantamine and rivastigmine are efficacious for mild to moderate Alzheimer's disease

Alzheimer's disease is the commonest cause of dementia affecting older people, and is associated with loss of cholinergic neurons in parts of the brain. Cholinesterase inhibitors (ChEIs), donepezil, galantamine and rivastigmine, delay the breakdown of acetylcholine released into synaptic clefts and so enhance cholinergic neurotransmission.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Donepezil is beneficial for people with mild, moderate and severe dementia due to Alzheimer's disease

Alzheimer's disease is the most common cause of dementia affecting older people, and is associated with loss of cholinergic neurons in parts of the brain. Acetylcholinesterase inhibitors, such as donepezil, delay the breakdown of acetylcholine released into synaptic clefts and so enhance cholinergic neurotransmission.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Comparing Alzheimer's Drugs

How do Alzheimer's drugs compare for treating symptoms?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: January 1, 2008

Alzheimer's disease: How effective are cholinesterase inhibitors?

Cholinesterase inhibitors can slightly delay the loss of mental abilities in people who have mild to moderate Alzheimer’s disease. But these medications may also cause nausea, vomiting or dizziness.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 18, 2013

Medications for the treatment of Alzheimer’s disease

There is currently no cure for Alzheimer’s disease. Various medications can somewhat delay the loss of mental abilities and independence. But they can also have side effects. It is not clear whether any of the medications are better than the others.Alzheimer’s disease is the most common cause of dementia. People who have dementia become forgetful and find it increasingly difficult to understand complex issues or express themselves in words. Their orientation in space and time gets worse and they need more and more support in everyday life. The speed at which the disease progresses varies greatly from person to person.In Alzheimer’s disease, more and more nerve cells in the brain die as time goes on. There is currently no way to cure the disease or stop its progression. But there are various medications which aim to maintain people’s memory and independence in everyday life for longer. Non-drug strategies include things like memory training or encouraging social activities.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: August 21, 2013

Interventions for preventing and ameliorating cognitive deficits in adults treated with cranial irradiation

Problems with mental activities (cognitive deficits) are common in patients who have received radiation to the brain for a primary or secondary (metastatic) brain tumour, or to help prevent a tumour spreading to the brain from elsewhere in the body. This toxic side effect of brain radiation may be acute (during treatment) or early after treatment (one to six months) and may be reversible. However, late toxicities may occur many months or years later and are generally irreversible and are slowly progressive. Late cognitive deficits, such as memory loss, problems planning tasks or behavioural changes, can have a serious impact on quality of life and the ability to carrying out activities normally. Interventions to help prevent or treat these late radiation toxicities may improve a patient's well‐being.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Hyperbaric oxygen therapy for vascular dementia

Hyperbaric oxygen therapy (HBOT) has been used to treat a variety of conditions and has shown possible efficacy for treating vascular dementia (VaD) in experimental and preliminary clinical studies. This review included one randomised controlled trial of poor methodological quality involving 64 patients with VaD who were also taking donepezil. Safety assessment was not mentioned at all. Although the authors reported cognitive benefit, this trial alone cannot be taken as evidence of efficacy. Further well‐designed randomised controlled trials are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

No convincing evidence from one trial of the efficacy of cholinesterase inhibitors for delirium

Delirium is a confusional state that is associated with physical illness. Its characteristic features are rapid onset, altered consciousness, reduced attention and global cognitive impairment. Other symptoms are hallucinations (particularly visual hallucinations), disturbed sleep pattern and agitation. Delirium is commonly found in hospital patients and is associated with longer admissions, poor functioning level, persistent cognitive impairment and need for institutional care. Delirium is therefore an important syndrome to recognise and treat. The one included trial, of donepezil compared with placebo in 15 patients, showed no statistically significant difference in length of delirium. No other outcomes were measured.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Medications for cognitive decline in people with Down syndrome

People with Down syndrome often experience cognitive decline (a deterioration in memory, language, thinking and judgment that are greater than normal age‐related changes) at a younger age and in greater numbers than the general population. Various medicines have been shown to improve, or at least slow down the progression of these symptoms in people without Down syndrome.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Pharmacological agents as symptomatic treatment for memory disorder in people with multiple sclerosis

This is an update of the Cochrane review "Pharmacologic treatment for memory disorder in multiple sclerosis" (first published in The Cochrane Library 2011, Issue 10).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Drug therapy for obstructive sleep apnoea in adults

Obstructive sleep apnoea (OSA) is caused by collapse of the upper airway. The mainstay of medical treatment is continuous positive airways pressure (CPAP), delivered through a mask during sleep, aiming to keep the airway opened. Drug therapy has been proposed for individuals with mild OSA and those intolerant of CPAP.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Pharmacological treatments for fatigue associated with advanced disease

In an advanced disease such as cancer, fatigue can be described as tiredness, weakness or lack of energy. Fatigue can affect daily activity and quality of life, and it is frequently reported by palliative care patients. The underlying causes of fatigue are not very well understood and fatigue is difficult to treat.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Cholinergic medication for neuroleptic‐induced tardive dyskinesia

Drug‐induced tardive dyskinesia is a common adverse effect of some antipsychotics, especially when these are given for an extended period of time. Tardive dyskinesia consists of involuntary repetitive movements, mainly in the oral region, but sometimes also in the limbs. It may become persistent. Cholinergic drugs, such as deanol, lecithin and meclofenoxate, have been used to treat tardive dyskinesia. This review did not identify any evidence to suggest that they are effective and found some to suggest that these old drugs may be toxic. New cholinergic drugs have been developed for the treatment of Alzheimer's disease, and it will be of interest to know if these drugs have an effect on the movements of tardive dyskinesia. We found one ongoing randomised trial.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Cholinesterase inhibitors are beneficial for people with Parkinson's disease and dementia

The clinical features of dementia with Lewy bodies (DLB) and Parkinson's disease with dementia (PDD) have much in common. As patients with DLB and PDD have particularly severe deficits in cortical levels of the neurotransmitter acetylcholine, blocking its breakdown using a group of chemicals known as cholinesterase inhibitors may lead to clinical improvement. Six trials showed a statistically significant improvement in global assessment, cognitive function, behavioural disturbance and activities of daily living rating scales in PDD and cognitive impairment in Parkinson's disease (CIND‐PD) patients treated with cholinesterase inhibitors. There was no current disaggregated evidence to support their use in CIND‐PD. In a single trial, no statistically significant improvement was observed in patients with DLB who were treated with cholinesterase inhibitors and further trials are necessary to clarify the effect of cholinesterase inhibitors in this patient group.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

[Cholinesterase inhibitors for rarer dementia associated with neurological conditions]

There are various rarer dementias including Huntington's disease (HD), cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), frontotemporal dementia (FTD), dementia in multiple sclerosis (MS) and progressive supranuclear palsy (PSP). A group of chemicals known as cholinesterase inhibitors are considered to be the first‐line medicines for Alzheimer's disease and some other dementias. Cholinesterase inhibitors may also lead to clinical improvement for rarer dementias associated with neurological conditions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

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