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Donepezil May Help in Parkinson's Disease

A treatment most commonly used among patients suffering from Alzheimer’s disease (AD), donepezil, may now have a place in treating dementia in Parkinson’s disease (PD). Over three to four years, thirty percent of PD patients will develop dementia, and it remains a limiting factor for the treatment of motor problems associated with PD. The rational behind the use of donepezil is due to the pathophysiological pathway involved in dementia associated with PD. Cholinergic deficits in PD are observed in those suffering from the cognitive decline of dementia. Donepezil is an anticholinesterase inhibitor that reduces the degradation of acetylcholine and has shown improvement in patients suffering cognitive decline in AD. However concern was raised because many PD patients are often treated with anticholinergic agents, thus cholinergic treatments such as donepezil could affect the motor deficits of PD.

A study was conducted to determine the effectiveness of donepezil in dementia related to PD. Donepezil had a small effect on cognitive function seen through the Mini Mental Status Exam (MMSE) and the Clinical Global Impression of Change (CGI), however on all other standard tests performed in the study, donepezil was not statistically significant from placebo. Among the PD patients, donepezil was well tolerated and did not affect other Parkinson’s symptoms. Overall, this appears to be a safe treatment with moderate effectiveness for patients suffering from dementia related to PD. Specific patient characteristics may determine who will respond to this treatment and further studies should be done to determine the true clinical usefulness of donepezil in PD patients.

References:
1. Ravina R, Putt M, Siderowf A, Farrar JT, Gillespie M, Crawley A, et al. Donepezil for dementia in Parkinson’s disease: a randomised, double blind, placebo controlled, crossover study. J Neurol Neurosurg Psychiatry 2005;76:934-939.

2. MedlinePlus: Alzheimer’s Drug may Help with Parkinson’s Too, June 30, 2005 http://www.nlm.nih.gov/medlineplus/news/fullstory_25527.html

Emily DeVault, Pharm.D. Candidate