Thursday, August 4

Cognitive Boost for Dementia with Lewy Bodies

Donepezil
GOOD NEWS: Donepezil (Aricept®), approved for Alzheimer's, also passed a long-term trial for Dementia with Lewy Bodies (DLB). Get the details on the medicine's positive results.



Dementia with Lewy bodies (DLB) is a common form of dementia in the elderly. It accounts for 10-15% of patients with dementia and constitutes the second largest group after Alzheimer's disease.

These 3 dementia drugs are similar.
They are all cholinesterase inhibitors:
Brand NameGeneric
Exelonrivastigmine
Ariceptdonepezil
Razadynegalantamine
Recent studies have shown that cholinesterase inhibitors like donepezil (Brand name: Aricept®) can help in the short term.

This study is the first to show how it can help over the long run.

Long-Term Results are Positive

The 108 patients with DLB who participated in this "extension study" were continuing on from an earlier, shorter 12-week clinical trial testing donepezil for DLB.

The latest results demonstrate that cognitive function and dementia-related behavioral symptoms, including cognitive fluctuations, were improved after the start of donepezil treatment, and maintained for 52 weeks. That is to say, an entire year of benefit was seen in this trial, and if the preceding 12-week period is included, an impressive 64 weeks of treatment efficacy was demonstrated.

The findings suggest that treatment efficacy of donepezil for these symptoms may be maintained for even longer than the 64 weeks of this trial. This is because no linear decrease in evaluation scores was observed.

DLB versus Alzheimer's

Donepezil was originally FDA-approved for Alzheimer's, for which there have been extensive trials. Therefore, a comparison of this DLB trial to similat Alzheimer's trials reveals important insights.

The results indicate that cognitive decline in DLB may be faster than or at least similar to that in Alzheimer's Disease (AD) patients. This implies that patients with DLB might be even more likely to benefit from donepezil treatment compared to Alzheimer's patients.

As for caregivers, the donepezil treatment seemed to help them avoid the typical increase in burden that typically occurs with an untreated patient over such a long period of time. In other words, the medicine did not improve the situation for the caregiver; notwithstanding, it succeeded in keeping the situation from getting any worse.

Side Effects

Unsurprisingly, a relationship between the washout period and attenuation in the treatment effect was suggested. Among patients who were assigned to the donepezil treatment groups in the preceding RCT, cognitive function and behavioral/psychiatric symptoms deteriorated more in patients with a longer washout period. This could indicate that the treatment effect might eventually diminish if donepezil administration was stopped for a long period of time.

Since there was no significant imbalance in the AE incidence analyzed by onset time, it is therefore suggested that delayed onset of AE induced by long-term donepezil administration is unlikely to appear in these patients. Patients with DLB may be at increased risk of bradyarrhythmia resulting from treatment with ChEIs though [14]. In this long-term study, however, only 2 patients experienced abnormal changes in pulse rate (1 bradycardia and 1 sinus bradycardia), and neither of these were serious. Also, long-term administration of donepezil is unlikely to worsen parkinsonian symptoms since UPDRS scores did not worsen over 52 weeks. Furthermore, only 3 patients received dose reductions to 3 mg/day due to AEs. Two of them completed this study with the reduced dose, thereby enabling the patients to continue treatment with donepezil by reducing the dosage to 3 mg/day. In comparison to a study of donepezil in patients with AD, AEs reported in this study were similar to those reported in the study of AD patients, except for parkinsonism [20].

Conclusions

The results appear to reliably indicate the efficacy of donepezil as a worthwhile treatment for DLB.

In conclusion, the long-term administration of donepezil at 5 mg/day was safe in patients with DLB, and is expected to exhibit lasting effects on improving impaired cognitive function and psychiatric symptoms.

5 comments :

  1. This comment has been removed by the author.

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  2. wife taken off donepezil due to her heart slowing,it was good now on risperidone not so effective.

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  3. About Dementia with Lewy Bodies,as a support therapy,researchers could study deeper the nutraceutical CARNOSINE,that is a heavy metal chelator,a peroxinitrites scavenger and anti-glycating agent,in small doses(only under physician prescription)has synergistic effects with ALCAR.And CARNOSINE,has the potential to lowers betamyloid accumulation in Alzheimer disease(1),lowers alpha-synuclein accumulation in Parkinson disease and in Dementia of Lewy Bodies(2),(3)and lowers the prion-like spreads(4)that happens inside the brain of AD,PD and DLB patients.Based in:1)"Anti-aggregating Effect of the Naturally Occurring Dipeptide Carnosine on Betamyloid Fibril Formation" 2013PLoS);2)"Antioxidative and Anti-inflammatory Protection From Carnosine in the Striatum of Treated Mice"(2010,J Agric Food Chem.);3)"Enhanced Oligomerization of the Alpha-Synuclein Mutant by the Copper,Zinc Superoxide Dismutase and Hydrogen Peroxide System"(2003,Molecules and Cells);4)"Zinc,Copper,and Carnosine Attenuate Neurotoxicity of Prion Fragment"Metallomics 2011)

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  4. In the research article with the title,"Effects of Acetyl-L-Carnitine In Alzheimer's Disease Patients Unresponsive to Acetylcholinesterase Inhibitor",by Bianchetti and colleagues,in the journal Current Medical Research,in 2003,we can read that ACETYL L CARNITINE(so called ALCAR)INCREASED IN FIFTY PERCENT THE EFFECTIVINESS OF DONEPEZIL(and of others acetylcholinesterase inhibitors too)when they gave donepezil together with ALCAR(only in small doses,under physician prescription).The authors concluded:"The association of Donepezil to ALCAR indicates that the combination of these two drugs may be a useful therapeutic option in AD patient".We can find the article searching in Google by it title above.

    ReplyDelete
  5. About Dementia with Lewy Bodies,as a support therapy,researchers could study deeper the nutraceutical CARNOSINE,that is a heavy metal chelator,a peroxinitrites scavenger and anti-glycating agent,in small doses(only under physician prescription)has synergistic effects with ALCAR.And CARNOSINE,has the potential to lowers betamyloid accumulation in Alzheimer disease(1),lowers alpha-synuclein accumulation in Parkinson disease and in Dementia of Lewy Bodies(2),(3)and lowers the prion-like spreads(4)that happens inside the brain of AD,PD and DLB patients.Based in:1)"Anti-aggregating Effect of the Naturally Occurring Dipeptide Carnosine on Betamyloid Fibril Formation" 2013PLoS);2)"Antioxidative and Anti-inflammatory Protection From Carnosine in the Striatum of Treated Mice"(2010,J Agric Food Chem.);3)"Enhanced Oligomerization of the Alpha-Synuclein Mutant by the Copper,Zinc Superoxide Dismutase and Hydrogen Peroxide System"(2003,Molecules and Cells);4)"Zinc,Copper,and Carnosine Attenuate Neurotoxicity of Prion Fragment"Metallomics 2011)

    ReplyDelete

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