Donepezil for dementia in people with Down syndrome

Abstract

To date there is only one small randomised controlled study on the effect of donepezil. This shows, at best, a modest, non statistically significant trend in favour of people with Down syndrome and Alzheimer's dementia who are able to tolerate donepezil (this drug is currently only dispensed in relatively large doses and is contraindicated for those with cardiac and respiratory problems).This study does not provide good evidence on which to base practice. Findings in an open-label follow up to this study suggest possible benefit in some individuals. Further, larger randomised controlled studies with longer-term follow up are required.

Down Syndrome and Dementia: Guide to Identification, Screening, and Management

“…Medications with psychoactive, sedating, antiepileptic, or anticholinergic properties are common causes of cognitive changes (delirium). 11 Polypharmacy is common and thus drug-drug interactions should be reviewed assessed for nonspecific signs and symptoms, such as somnolence, gait instability, and urinary retention. Collaboration with a pharmacist may be useful in evaluating drug-drug interactions and for the pharmacy cascade.…”

“…The NP should consider assessing for adherence to medication dose and frequency, as nonadherence can also be a source of CBF changes. 11,12 CHRONIC HEALTH PROBLEMS Many chronic health conditions (multimorbidity) are associated with DS, can be exacerbated during aging, and may be associated with CBF changes. Adults with DS may have multiple (4 or more) comorbid conditions due to underlying physical abnormalities as well as metabolic effects of long-term medication use, such as seizure or antipsychotic medications.…”

“…Adults with DS may have multiple (4 or more) comorbid conditions due to underlying physical abnormalities as well as metabolic effects of long-term medication use, such as seizure or antipsychotic medications. 11 Health problems associated with aging and DS are numerous and may be etiologies of cognitive changes, and their presentations may differ from the usual aging patterns (see Box 1). 13 For example, thyroid disorders have been reported to have a 40% prevalence in the DS population as compared with a 10% prevalence in an age-matched population.…”

“…Keratoconus causes the round cornea to become cone-shaped, which can lead to a distortion of vision. 11 Persons with DS often have hearing impairment. The accelerated aging process places them at high risk for conductive hearing loss.…”

Pharmacological Strategies for Enhancing Cognition in Schizophrenia

“…Further, much research points to a consistent impairment in the cholinergic system in dementias such as Alzheimer's disease that involve impairments in memory as well as other cognitive functions (Schliebs and Arendt 2006). Not surprisingly, drugs that enhance the function of the cholinergic system have been a major focus of treatment for Alzheimer's disease and other neurological disorders involving memory impairment (Birks et al 2009;Cincotta et al 2008;Mohan et al 2009;Razay and Wilcock 2008;Reingold et al 2007). …”