Increased dosage of donepezil for the management of behavioural and psychological symptoms of dementia in dementia with <scp>L</scp>ewy bodies

Manabe, Yuta; Ino, Teruo; Yamanaka, Katsuo; Kosaka, Kenji

doi:10.1111/psyg.12140

Cited by 11 publications

(11 citation statements)

References 13 publications

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“…Persons with dementia and reported suicidal ideation in this study more often were on anxiolytics and antidementia medication (acetylcholinesterase inhibitors and memantine). This was unexpected as anti-dementia medication is considered to improve neuropsychiatric symptoms (Finkel, 2004;Huang, Lin, Lane, & Tsai, 2012;Manabe, Ino, Yamanaka, & Kosaka, 2016;Olsen, Poulsen, & Lublin, 2005). One explanation may be that the prescription of these pharmaceuticals may vary depending on the stage of dementia, in favour of the mild and moderate stage.…”

Section: Discussionmentioning

confidence: 99%

Associated factors of suicidal ideation among older persons with dementia living at home in eight European countries

Holmstrand

Hallberg

Saks

et al. 2020

Aging & Mental Health

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Objectives: This study aimed to investigate the occurrence of suicidal ideation and associated factors in older persons with dementia living at home in eight European countries, and its association with quality of life. Furthermore, changes in suicidal ideation over time were investigated. Methods: This cohort study (n ¼ 1,223) was part of the European "RightTimePlaceCare" project conducted in 2010-2013. Participating countries were Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden and the United Kingdom. Baseline and follow-up data were analysed using bivariate and multivariate logistic regression. Results: The occurrence of suicidal ideation in the participating countries varied between 6% and 24%. Factors significantly (p < 0.0018) associated with suicidal ideation using bivariate analysis were: nationality, depressive symptoms, delusions, hallucinations, agitation, anxiety, apathy, disinhibition, irritability, night-time behaviour disturbances, anxiolytics and anti-dementia medication. In the multivariate regression analysis, country of origin, moderate stage of the dementia, depressive and delusional symptoms, and anti-dementia medication were significantly associated with suicidal ideation (p < 0.05). Over time, suicidal ideation decreased from severe to mild or became absent in 54% of the persons with dementia. Conclusion: It is essential that professionals identify older persons with dementia and suicidal ideation and depressive and other psychological symptoms in order to give them appropriate treatment and provide relief for their informal caregivers. We emphasize the importance of identifying suicidal ideation, irrespective of depressive symptoms, and specifically of paying attention to persons with moderate dementia. Living with the informal caregiver seems to be associated with staying stable without suicidal ideation.

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Section: Discussionmentioning

confidence: 99%

Associated factors of suicidal ideation among older persons with dementia living at home in eight European countries

Holmstrand

Hallberg

Saks

et al. 2020

Aging & Mental Health

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“…Consistent with the results of previous meta-analyses, the present study indicated that donepezil was beneficial for DLB regarding cognitive function and global impression, but not in any other aspects. Recently published secondary analyses of donepezil suggest statistically significant advantages of donepezil over placebo regarding aspects of Behavioural and Psychological Symptoms of Dementia (BPSD), improvement of cognitive function and visual hallucinations (36–38). Manabe et al (36) observed that 10 mg donepezil improved BPSD in DLB.…”

Section: Discussionmentioning

confidence: 99%

Cholinesterase inhibitors and memantine for Parkinson's disease dementia and Lewy body dementia: A meta‑analysis

et al. 2018

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Recently, several randomized controlled trials on the use of cholinesterase inhibitors or memantine as treatments for cognitive impairment in Parkinson's disease (CIND-PD), Parkinson's disease with dementia (PDD) and dementia with Lewy bodies (DLB) were completed. The present study provided a meta-analysis of these studies to evaluate the efficacy of cholinesterase inhibitors and memantine on CIND-PD, PDD and DLB. The Cochrane Library, Pubmed, Embase and Web of Science databases were searched to retrieve eligible studies. As primary efficacy outcomes, cognitive function, global impression, behavioral symptoms and motor function were selected, while falling and adverse events were regarded as safety outcomes. Of note, domain-specific cognitive function was assessed as a primary efficacy outcome and falling as a safety outcome, which, to the best of our knowledge, has not been studied previously in CIND-PD, PDD and DLB. A total of 15 trials were included in the present meta-analysis. The results revealed that treatment with cholinesterase inhibitors resulted in improvements in cognitive function, the clinician's global impression, behavioral symptoms and motor function, in accordance with the results of previous studies. Furthermore, it was revealed that cholinesterase inhibitors had a significant effect on attention, processing speed, executive functions, memory and language; however, they did not improve visuospatial cognition compared with placebos. Memantine had a significant effect on attention, processing speed and executive functions. In addition, cholinesterase inhibitors and memantine did not significantly reduce falling. It was demonstrated that an increased number of adverse events occurred in the pooled cholinesterase inhibitors and memantine group, compared with that in the placebo group (risk ratio (RR)=1.09; 95% confidence interval (CI): 1.04–1.16; P=0.001); however, in the subgroup analysis, only the rivastigmine group experienced significantly more adverse events than the placebo group (85 vs. 73%; RR=1.18; 95% CI: 1.08–1.29; P=0.0001), but donepezil and memantine did not produce any significant adverse events. In conclusion, cholinesterase inhibitors and memantine have an effect not only on global cognitive function and motor function, but also on attention, processing speed, executive functions, memory and language. However, careful monitoring of the side effects of rivastigmine may be required. Further clinical trials are required to verify these conclusions.

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“… An open label study of 24 patients with DLB who had relapse of NPS after treatment with donepezil 5 mg found that NPI scores improved significantly for six of 10 behaviors after a dose increase to donepezil 10 mg. Importantly, visual hallucinations were significantly improved at weeks 2 (mean score, 2.80; P < 0.0001) and 4 (mean score 2.85; P < 0.0001) from baseline (mean score, 8.23) .…”

Section: Treatment For Dlbmentioning

confidence: 92%

Role of Donepezil in the Management of Neuropsychiatric Symptoms in Alzheimer's Disease and Dementia with Lewy Bodies

et al. 2016

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SUMMARY Alzheimer’s disease (AD) is a progressive condition that affects cognition, function, and behavior. Approximately 60–90% of patients with AD develop neuropsychiatric symptoms (NPS) such as hallucinations, delusions, agitation/aggression, dysphoria/depression, anxiety, irritability, disinhibition, euphoria, apathy, aberrant motor behavior, sleep disturbances, appetite and eating changes, or altered sexual behavior. These noncognitive behavior changes are thought to result from anatomical and biochemical changes within the brain, and have been linked, in part, to cholinergic deficiency. Cholinesterase inhibitors may reduce the emergence of NPS and have a role in their treatment. These agents may delay initiation of, or reduce the need for, other drugs such as antipsychotics. This article summarizes the effects of donepezil, a cholinesterase inhibitor, on the NPS of dementia with emphasis on AD and dementia with Lewy bodies.

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Increased dosage of donepezil for the management of behavioural and psychological symptoms of dementia in dementia with Lewy bodies

Abstract: 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.

Cited by 11 publications

References 13 publications

Associated factors of suicidal ideation among older persons with dementia living at home in eight European countries

Associated factors of suicidal ideation among older persons with dementia living at home in eight European countries

Cholinesterase inhibitors and memantine for Parkinson's disease dementia and Lewy body dementia: A meta‑analysis

Role of Donepezil in the Management of Neuropsychiatric Symptoms in Alzheimer's Disease and Dementia with Lewy Bodies

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