title: Analyzing the impact of 23 mg/day donepezil on language dysfunction in moderate to severe Alzheimer's disease.
abstract: BACKGROUND
  Progressive language impairment is among the primary components of cognitive decline in Alzheimer's disease (AD). Because expressive and receptive language help to maintain emotional connections to caregivers and support the management of AD patients' functional needs, language plays a critical role in patients' emotional and physical health. Using data from a large prospective clinical trial comparing two doses of donepezil in patients with moderate to severe AD, we performed a post hoc analysis to determine whether a higher dose of donepezil was associated with greater benefits in language function.
  
  
  METHODS
  In the original randomized, double-blind clinical trial, 1,467 patients with moderate to severe AD (baseline Mini-Mental State Examination (MMSE) score 0 to 20) were randomized 2:1 to receive donepezil 23 mg/day or to continue on donepezil 10 mg/day for 24 weeks. In this post hoc analysis, the Severe Impairment Battery-Language scale (SIB-L) and a new 21-item SIB-derived language scale (SIB[lang]) were used to explore differences in language function between the treatment groups. Correlations between SIB-L and SIB[lang] scores and scores on the severe version of the Alzheimer's Disease Cooperative Study-Activities of Daily Living inventory (ADCS-ADL-sev), the Clinician's Interview-Based Impression of Severity-plus caregiver input/Clinician's Interview-Based Impression of Change-plus caregiver input (CIBIS-plus/CIBIC-plus) and the MMSE were also investigated.
  
  
  RESULTS
  At week 24, treatment with donepezil 23 mg/day was associated with an improvement in language in the full intention-to-treat population, whereas language function declined in the group treated with donepezil 10 mg/day (SIB-L treatment difference 0.8, P = 0.0013; SIB[lang] treatment difference 0.8, P = 0.0009). Similar results were observed in a cohort of patients with more severe baseline disease (MMSE score 0 to 16). At baseline and week 24, correlations between the SIB-derived language scales and the ADCS-ADL-sev and CIBIC-plus were moderate, but the correlations were stronger between the language scales and the MMSE scores.
  
  
  CONCLUSIONS
  Patients with moderate to severe AD receiving donepezil 23 mg/day showed greater language benefits than those receiving donepezil 10 mg/day as measured by SIB-derived language assessments. Increasing the dose of donepezil to 23 mg/day may provide language benefits in patients with moderate to severe AD, for whom preservation of language abilities is especially critical.ClinicalTrials.gov identifier: NCT00478205.
authors.affiliation: Alzheimer Disease Center, Centre of Excellence on Brain Aging, New York University Langone Medical Center, 145 East 32nd Street, New York, NY 10016, USA. Steven.Ferris@nyumc.org.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Ferris
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Schmitt
authors.forename: Judith
authors.initials: J
authors.lastname: Saxton
authors.forename: Sharon
authors.initials: S
authors.lastname: Richardson
authors.forename: Joan
authors.initials: J
authors.lastname: Mackell
authors.forename: Yijun
authors.initials: Y
authors.lastname: Sun
authors.forename: Yikang
authors.initials: Y
authors.lastname: Xu