A comparison of the efficacy of donepezil in Parkinson's disease with Dementia and Dementia with Lewy bodies

Authors

  • Alan J. Thomas,

    1. Institute for Ageing and Health, University of Newcastle upon Tyne, Wolfson Research Centre, Newcastle General Hospital, Newcastle upon Tyne, UK
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  • David J. Burn,

    1. Institute for Ageing and Health, University of Newcastle upon Tyne, Wolfson Research Centre, Newcastle General Hospital, Newcastle upon Tyne, UK
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  • Elise N. Rowan,

    1. Institute for Ageing and Health, University of Newcastle upon Tyne, Wolfson Research Centre, Newcastle General Hospital, Newcastle upon Tyne, UK
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  • Elizabeth Littlewood,

    1. Institute for Ageing and Health, University of Newcastle upon Tyne, Wolfson Research Centre, Newcastle General Hospital, Newcastle upon Tyne, UK
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  • Jane Newby,

    1. Institute for Ageing and Health, University of Newcastle upon Tyne, Wolfson Research Centre, Newcastle General Hospital, Newcastle upon Tyne, UK
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  • David Cousins,

    1. Institute for Ageing and Health, University of Newcastle upon Tyne, Wolfson Research Centre, Newcastle General Hospital, Newcastle upon Tyne, UK
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  • Sanjeet Pakrasi,

    1. Institute for Ageing and Health, University of Newcastle upon Tyne, Wolfson Research Centre, Newcastle General Hospital, Newcastle upon Tyne, UK
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  • Jonathan Richardson,

    1. Institute for Ageing and Health, University of Newcastle upon Tyne, Wolfson Research Centre, Newcastle General Hospital, Newcastle upon Tyne, UK
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  • Jonathan Sanders,

    1. Institute for Ageing and Health, University of Newcastle upon Tyne, Wolfson Research Centre, Newcastle General Hospital, Newcastle upon Tyne, UK
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  • Ian G. McKeith

    Corresponding author
    1. Institute for Ageing and Health, University of Newcastle upon Tyne, Wolfson Research Centre, Newcastle General Hospital, Newcastle upon Tyne, UK
    • Wolfson Research Centre, Institute for Ageing and Health, Newcastle General Hospital, Newcastle upon Tyne, NE4 6BE, UK.
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Abstract

Background

Parkinson's disease with dementia (PDD) and dementia with Lewy bodies (DLB) overlap in phenomenology and neurochemical deficits. We hypothesised they would not differ in their response to the cholinesterase inhibitor donepezil.

Methods

We recruited 70 subjects, 30 DLB and 40 PDD, in an open label study to compare the efficacy of donepezil in these two patient groups. They were assessed at baseline, 4, 12 and 20 weeks. The main outcome measures were the Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI) and motor sub-section of the Unified Parkinson's Disease Rating Scale (UPDRS III).

Results

PDD patients were younger than DLB and had more severe parkinsonism at baseline. The groups were similar on all other variables of interest. By 20 weeks the mean MMSE score increased by 3.9 points in the DLB group and by 3.2 points in PDD. The mean NPI score reduced by 14.6 points for DLB and 12.0 points for PDD. These treatment effects were all significant compared to baseline (p < 0.001) but there were no significant between-group treatment differences (MMSE p = 0.56, NPI p = 0.39). UPDRS III motor scores did not change significantly from baseline values in either group. Although adverse effects were common (69%) they were usually mild and 64 patients (91%) completed the study. The four patients who did withdraw with adverse effects all had a PDD diagnosis.

Conclusions

Donepezil produced similar improvements in cognition and behaviour in DLB and PDD. This supports the hypothesis that the two disorders are closely related clinically and neurobiologically. Larger scale, placebo controlled clinical trials are needed to provide an evidence base to guide the clinical use of cholinesterase inhibitors in Lewy body disease. Copyright © 2005 John Wiley & Sons, Ltd.

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