title: Increased dosage of donepezil for the management of behavioural and psychological symptoms of dementia in dementia with Lewy bodies.
abstract: BACKGROUND
  As with other types of dementia, the behavioral and psychological symptoms of dementia (BPSD) can make caregiving difficult for patients with dementia with Lewy bodies (DLB). We hypothesized that administration of donepezil at an increased dose of 10 mg/day might dose-dependently improve BPSD in DLB patients with relapse, after their symptoms had been controlled initially by donepezil therapy at the standard dose.
  
  
  METHODS
  The present study was as an open-label trial. We enrolled 24 patients with DLB (diagnosed according to the Consortium on Dementia with Lewy Bodies Guideline-Revised) who experienced a relapse of BPSD despite treatment with donepezil at the standard dose (5 mg/day). The donepezil dose for these patients was increased to 10 mg/day, and we evaluated the efficacy and safety of this dose escalation strategy.
  
  
  RESULTS
  The Neuropsychiatric Inventory (NPI) scores for BPSD showed statistically significant improvements as a result of the increased dosage, except those for anxiety and euphoria, disinhibition, irritability/lability. High-dose donepezil therapy caused gastrointestinal symptoms in 4 patients, but there were no life-threatening adverse events, such as arrhythmias, or no exacerbation of parkinsonian symptoms.
  
  
  CONCLUSIONS
  We found that donepezil dose-dependently improved relapsing BPSD in these patients. Therefore, increasing the dosage of donepezil is a safe and effective treatment for patients with DLB who experience a relapse of BPSD.
authors.affiliation: Dementia Diagnosis Center, Department of Internal Medicine, Yokohama Shintoshi Neurosurgical Hospital, Yokohama, Japan.|Medical Care Court Clinic, Yokohama, Japan.|Department of Emergency and General Internal Medicine, Fujita Health University, School of Medicine, Toyoake, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Manabe
authors.affiliation: Department of Emergency and General Internal Medicine, Fujita Health University, School of Medicine, Toyoake, Japan.
authors.forename: Teruo
authors.initials: T
authors.lastname: Ino
authors.affiliation: Department of Emergency and General Internal Medicine, Fujita Health University, School of Medicine, Toyoake, Japan.
authors.forename: Katsuo
authors.initials: K
authors.lastname: Yamanaka
authors.affiliation: Medical Care Court Clinic, Yokohama, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kosaka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001519:Behavior / Q000187:drug effects*; D001526:Behavioral Symptoms; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D003071:Cognition / Q000187:drug effects*; D003704:Dementia / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D000077265:Donepezil; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007189:Indans / Q000008:administration & dosage* / Q000627:therapeutic use; D020961:Lewy Body Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage* / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D000077265:Donepezil
keywords: Alzheimer's disease; Lewy bodies; Neuropsychiatric Inventory; behavioral and psychological symptoms of dementia; cholinesterase inhibitors; hallucination