title: Efficacy of Cholinesterase Inhibitors in Vascular Dementia: An Updated Meta-Analysis.
abstract: OBJECTIVE
  The objective of this study was to determine whether treatment with acetylcholinesterase inhibitors would provide cognitive benefit for patients with vascular dementia.
  
  
  METHODS
  Studies in patients with vascular dementia, who had not taken acetylcholinesterase inhibitors or memantine for at least 6 weeks, were included.
  
  
  RESULTS
  Twelve studies were included in the final analysis. Donepezil showed significant improvement in Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) as compared to placebo, at the doses tested, that is, 5 and 10 mg/day (difference in means -1.389 and -1.680, respectively, p ≤ 0.008), but not on the Mini Mental State Examination (MMSE) (p ≥ 0.259). Galantamine also improved the ADAS-cog in comparison to the placebo (difference in means -2.191, p < 0.001), whereas, rivastigmine did not show any benefit on ADAS-cog. However, the findings with rivastigmine are difficult to interpret, given there were only 2 studies. Treatment with cholinesterase inhibitors was associated with a twofold increase in the odds of discontinuation, due to adverse events (pooled OR 1.966, 95% CI 1.630-2.371, p < 0.001).
  
  
  CONCLUSIONS
  The present results reveal the therapeutic benefits of donepezil and galantamine in patients with vascular dementia. Interestingly, the ADAS-cog and MMSE varied considerably in detecting cognitive improvement.
authors.affiliation: Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
authors.forename: Yu-dan
authors.initials: YD
authors.lastname: Chen
authors.forename: Juan
authors.initials: J
authors.lastname: Zhang
authors.forename: Yue
authors.initials: Y
authors.lastname: Wang
authors.forename: Jun-liang
authors.initials: JL
authors.lastname: Yuan
authors.forename: Wen-li
authors.initials: WL
authors.lastname: Hu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D015140:Dementia, Vascular / Q000188:drug therapy*; D000077265:Donepezil; D005260:Female; D005702:Galantamine / Q000627:therapeutic use; D006801:Humans; D007189:Indans / Q000627:therapeutic use; D009483:Neuropsychological Tests; D010880:Piperidines / Q000627:therapeutic use; D000068836:Rivastigmine / Q000627:therapeutic use
chemical_list: D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D005702:Galantamine; D000077265:Donepezil; D000068836:Rivastigmine