Consider The Evidence: Med/Peds Journal Roundup

April 3, 2006

Donzepil in severe dementia: Not too little too late

Filed under: alzheimer's disease, lancet — medblog @ 10:57 pm

Lancet 4/1 – Although Donzepil has been shown to slow the inevitable progression of Alzheimer's dementia (AD), its effects are often subtle, even in mild disease. In the severe stages, it may be difficult to ascertain any benefit, and the drug is often discontinued with the thinking that it is no longer effective.

Winblad et al. studied the efficacy of donzepil in a population with severe AD. They found a significant preseveration in multiple measures of disease and impairment severity including MMSE score. The effects were significant in an intent-to-treat analysis despite a nearly 12% greater level of discontinuation among the Donzepil group.

The study shows a clear benefit to starting donzepil despite advanced disease stage. However, the study did not specifically look at the effect of continuing therapy from the mild stage through the severe stage. The study patients had limited or no exposure to cholinergic inhibitors before the trial, and it remains unclear whether the effect would be similar in patients already on long term therapy.

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