From the Guidelines
Donepezil should be considered for patients with vascular dementia, as it has been shown to improve cognition and global function assessment, although the effects are small. The evidence from a systematic review published in the Annals of Internal Medicine in 2008 1 suggests that donepezil, at both 5 and 10 mg, improves cognition and global function assessment for patients with vascular dementia. The summary estimates for the ADAS-cog and the CIBIC-plus suggest that these effects are small, but clinically significant changes are demonstrated with the CIBIC-plus.
When prescribing donepezil for vascular dementia, it is essential to consider the potential benefits and risks, including adverse events such as gastrointestinal problems, which are dose-related. The typical starting dose is 5 mg once daily, usually taken at bedtime, with a potential increase to 10 mg daily after 4-6 weeks if tolerated.
Some key points to consider when managing patients with vascular dementia include:
- Addressing underlying cardiovascular risk factors such as hypertension, diabetes, and hyperlipidemia to help slow disease progression
- Non-pharmacological approaches like cognitive stimulation, physical exercise, and social engagement as important components of vascular dementia management
- Evaluating patients for conditions that might increase the risk of adverse effects, including cardiac conduction abnormalities, history of seizures, asthma, or peptic ulcer disease, before starting donepezil.
Overall, while the evidence for donepezil in vascular dementia is modest, it may be a useful treatment option for some patients, and its use should be considered in the context of overall patient management.
From the Research
Donepezil for Vascular Dementia
- Donepezil has been shown to be effective in improving cognitive function in patients with vascular dementia, with a number needed to treat (NNT) of 10 2.
- The medication has also been found to be well tolerated, with a number needed to harm (NNH) of 50 2.
- Studies have demonstrated that donepezil 5 mg/day and 10 mg/day can improve cognition, global function, and activities of daily living in patients with vascular dementia 3, 4, 5.
- A network meta-analysis found that donepezil 10 mg had the greatest effect on cognition, but also had more adverse events than placebo 6.
- The evidence suggests that donepezil may be a useful treatment option for patients with vascular dementia, although the size of the effect is unlikely to be clinically important 6.
Efficacy of Donepezil
- Donepezil 5 mg/day has been shown to improve cognition, with a mean difference of -0.92 on the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) 6.
- Donepezil 10 mg/day has been found to improve cognition, with a mean difference of -2.21 on the ADAS-Cog 6.
- The medication has also been found to improve global function and activities of daily living in patients with vascular dementia 3, 4, 5.
Safety and Tolerability
- Donepezil has been found to be well tolerated, with a low withdrawal rate due to adverse events 3, 4, 5.
- The most common adverse events reported with donepezil include nausea, diarrhea, dizziness, and headache 3, 4, 5.
- The evidence suggests that donepezil 10 mg/day may have more adverse events than placebo, but the effect is still considered to be modest 6.