title: Discontinuation of donepezil for the treatment of Alzheimer's disease in geriatric practice.
abstract: BACKGROUND
  Maintaining continuous pharmacological treatment of patients with dementia is often difficult. In the current study we surveyed the discontinuation of donepezil, a cholinesterase inhibitor, for the treatment of Alzheimer's disease in a Japanese geriatric outpatient clinic in a university hospital.
  
  
  METHODS
  Using a retrospective chart review from 1 July 2003 to 30 June 2005, prescriptions of donepezil and the reasons for discontinuing the prescription in a university hospital were determined. The severity of dementia was evaluated by the clinical dementia rating (CDR).
  
  
  RESULTS
  Out of 264 patients, 140 (53.1%) discontinued taking donepezil during the two-year observation period. The mean age of the continued group and the discontinued group did not differ significantly (79.5 +/- 6.7, 79.8 +/- 6.4, respectively). Kaplan-Meier analysis showed that the patients with more severe cognitive impairment (CDR score = 3) discontinued donepezil earlier and more frequently. The reasons for discontinuation were a change in the doctors treating the patients (n = 71), ineffectiveness (n = 16), gastrointestinal side-effects (n = 11), and others (n = 41). In patients with CDR = 1 or 2, changes of doctors were the most frequent reason for discontinuation. However, in patients with CDR = 3, ineffectiveness of the medication was the major reason for discontinuation.
  
  
  CONCLUSIONS
  Donepezil was frequently discontinued, and the rate of discontinuation was higher in patients with advanced dementia.
authors.affiliation: Department of Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan. umegaki@med.nagoya-u.ac.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Umegaki
authors.forename: Akio
authors.initials: A
authors.lastname: Itoh
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Nabeshima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy*; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D000077265:Donepezil; D005260:Female; D006801:Humans; D007189:Indans / Q000008:administration & dosage* / Q000009:adverse effects; D007564:Japan; D053208:Kaplan-Meier Estimate; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D010880:Piperidines / Q000008:administration & dosage* / Q000009:adverse effects; D011594:Psychometrics; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D000077265:Donepezil