Donepezil for dementia in Parkinson's disease: a randomised, double blind, placebo controlled, crossover study.
OBJECTIVE
To study the safety and efficacy of a cholinesterase inhibitor, donepezil hydrochloride, for the treatment of dementia in Parkinson's disease (PD).


METHODS
This was a randomised double blind, placebo controlled, crossover study in 22 subjects with PD and dementia. Participants were randomised to receive either donepezil followed by identical placebo, or placebo followed by donepezil. Donepezil was administered at 5-10 mg/day. Treatment periods were 10 weeks with a washout period of 6 weeks between the two periods. The primary outcome measure was the Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAScog).


RESULTS
Donepezil was well tolerated and most adverse events were mild. There was no worsening of PD symptoms as measured by the total or motor sections of the Unified Parkinson's Disease Rating Scale.There was a 1.9 point trend toward better scores on the ADAScog on treatment compared with placebo that was not statistically significant. The secondary cognitive measures showed a statistically significant 2 point benefit on the Mini Mental Status Examination and no change on the Mattis Dementia Rating Scale (MDRS). The Clinical Global Impression of Change (CGI) showed a significant 0.37 point improvement on donepezil. No improvement was observed on the MDRS or the Brief Psychiatric Rating Scale. Carryover between treatment periods was observed but was not statistically significant.


CONCLUSIONS
Donepezil was well tolerated and did not worsen PD. There may be a modest benefit on aspects of cognitive function. The possible clinical benefit measured by CGI was reflected in only one of the cognitive scales used in this study.
Ravina
B
B
NINDS, Neuroscience Center Rm 2225, 6001 Executive Blvd, Rockville, MD 20892-9257, USA. ravinab@ninds.nih.gov
Putt
M
M
Siderowf
A
A
Farrar
J T
JT
Gillespie
M
M
Crawley
A
A
Fernandez
H H
HH
Trieschmann
M M
MM
Reichwein
S
S
Simuni
T
T
D000368:Aged; D000369:Aged, 80 and over; D002800:Cholinesterase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D018592:Cross-Over Studies; D003704:Dementia / Q000175:diagnosis / Q000188:drug therapy*; D000077265:Donepezil; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007189:Indans / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000175:diagnosis / Q000188:drug therapy*; D010880:Piperidines / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D000077265:Donepezil