From the Guidelines
Donepezil is not specifically recommended for treating agitation in dementia. While donepezil (commonly sold as Aricept) is FDA-approved for treating cognitive symptoms in Alzheimer's disease, clinical evidence does not strongly support its use for behavioral symptoms like agitation 1. For agitation in dementia, non-pharmacological approaches are typically recommended first, including:
- Identifying and addressing underlying causes
- Maintaining routine
- Creating a calm environment
- Using redirection techniques If medication becomes necessary, clinicians typically consider antipsychotics like risperidone (0.25-1mg daily) or quetiapine (25-200mg daily) for short-term use, though these carry significant risks including increased mortality in elderly patients with dementia 1. Some providers may try citalopram (10-20mg daily) or other SSRIs which have shown modest benefit with fewer risks. Donepezil may indirectly help some patients by improving overall cognition, but it can occasionally worsen agitation as a side effect 1. Any medication approach should involve careful monitoring, using the lowest effective dose for the shortest necessary duration, and regular reassessment of risks versus benefits. The most recent guideline from the American Psychiatric Association emphasizes the judicious use of antipsychotic medications and highlights the importance of balancing potential benefits and harms 1.
From the Research
Effectiveness of Donepezil for Treating Agitation in Patients with Dementia
- The effectiveness of donepezil (Aricept) for treating agitation in patients with dementia is a topic of interest, with several studies investigating its use 2, 3, 4, 5, 6.
- A study published in 2007 found that donepezil was not more effective than placebo in treating agitation in patients with Alzheimer's disease, with no significant difference in the change in Cohen-Mansfield Agitation Inventory (CMAI) scores from baseline to 12 weeks 5.
- Another study published in 2003 found that donepezil improved cognitive function, activities of daily living, and behavior in patients with mild, moderate, or severe dementia due to Alzheimer's disease, but did not specifically address agitation 4.
- A review published in 2019 discussed the management of agitation in persons with dementia, including the use of acetylcholinesterase inhibitors like donepezil, but did not provide conclusive evidence for its effectiveness in treating agitation 3.
- A study published in 2015 discussed the use of donepezil across the spectrum of Alzheimer's disease, including its dose optimization and clinical relevance, but did not specifically address its use for treating agitation 6.
Comparison with Other Treatments
- Other studies have investigated the use of risperidone for managing agitation in patients with dementia, with some evidence suggesting its effectiveness 2, 3.
- The use of citalopram and other medications has also been discussed in the context of treating agitation in dementia patients, highlighting the complexity of managing this symptom 3.
Limitations and Future Directions
- The current evidence suggests that donepezil may not be effective for treating agitation in patients with Alzheimer's disease, but more research is needed to fully understand its potential benefits and limitations 5.
- Further studies are required to investigate the effectiveness of donepezil and other medications for managing agitation in dementia patients, taking into account the heterogeneity of patients and their comorbidities 3.