Randomized, Placebo-Controlled, Clinical Trial of Donepezil in Vascular Dementia: Differential Effects by Hippocampal Size
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Background and Purpose— We sought to assess the efficacy and safety of donepezil in patients with vascular dementia (VaD) fulfilling National Institute of Neurological Disorders and Stroke–Association Internationale pour la Recherche et l’Enseignement en Neurosciences criteria. Methods— This international, multicenter, 24-week trial was conducted from March 2003 to August 2005. Patients (N=974; mean age, 73.0 years) with probable or possible VaD were randomized 2:1 to receive donepezil 5 mg/d or placebo. Coprimary outcome measures were scores on the Vascular-Alzheimer Disease Assessment Scale–Cognitive Subscale and Clinician’s Interview–Based Impression of Change, plus carer interview. Analyses were performed for the intent-to-treat population with the last-observation-carried-forward method. Results— Compared with placebo, donepezil-treated patients showed significant improvement from baseline to end point on the Vascular-Alzheimer Disease Assessment Scale–Cognitive Subscale (least-squares mean difference, −1.156; 95% CI, −1.98 to −0.33; P <0.01) but not on the Clinician’s Interview–Based Impression of Change, plus carer interview. Patients with hippocampal atrophy who were treated with donepezil demonstrated stable cognition versus a decline in the placebo-treated group; in those without atrophy, cognition improved with donepezil versus relative stability with placebo. Results on secondary efficacy measures were inconsistent. The incidence of adverse events was similar across groups. Eleven deaths occurred in the donepezil group (1.7%), similar to rates previously reported for donepezil trials in VaD, whereas no deaths occurred in the placebo group. Conclusions— Patients treated with donepezil 5 mg/d demonstrated significant improvement in cognitive, but not global, function. Donepezil was relatively well tolerated; adverse events were consistent with current labeling. Mortality in the placebo group was unexpectedly low. The differential treatment response of VaD patients by hippocampal size suggests that hippocampal imaging warrants further investigation for understanding VaD.
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Donepezil produced cognitive benefit in VaD, but global and functional efficacy was less consistent across individual studies.
“Cognitive benefit was found, but global and functional efficacy was less consistent in the individual studies.396,400”
Among 3 donepezil trials, all found significant benefit for cognition.
“Among the 3 trials conducted with donepezil, all found a significant benefit for cognition, 261-263”
From Vascular Cognitive Impairment (2017) · cites this paper as [263]
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- Authors
- Román, G. C., Salloway, S., Black, S. E., Royall, D. R., DeCarli, C., Weiner, M. W., Moline, M., Kumar, D., Schindler, R., & Posner, H.
- Affiliations
- From the Department of Neurology (G.C.R.), School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Tex; Department of Neurology and the Memory and Aging Program (S.S.), Brown Alpert Medical School, Butler Hospital, Providence, RI; Department of Neurology (S.E.B.), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Canada; Departments of Psychiatry, Medicine, Pharmacology, and Family and Community Medicine, Division of Aging and Geriatric Psychiatry ...
- San Francisco VA Medical Center (US)
- ORCID
- Venue
- Stroke
- Published
- 2010-06
- Volume
- 41
- Issue
- 6
- Pages
- 1213-1221
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- PMC
- PMC2954887
- OpenAlex
- W2155669855
- Cited by
- 161
- References
- 30
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 12 · 2023: 4 · 2022: 9 · 2021: 10 · 2020: 11 · 2019: 6 · 2018: 9 · 2017: 11 · 2016: 15 · 2015: 11 · 2014: 11 · 2013: 12 · 2012: 9
- FWCI
- 8.07
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Pfizer
- Eisai
- National Institute on Aging (P30AG010129)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Neurology › Neurological Disease Mechanisms and Treatments
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Keywords
- donepezil, vascular dementia, cholinesterase inhibitors, cognitive function, hippocampal atrophy, mortality, adverse events, treatment response
- MeSH terms
- Donepezil, Adult, Aged, Aged, 80 and over, Cognition, Double-Blind Method, Female, Hippocampus, Humans, Indans, Male, Middle Aged, Organ Size, Piperidines, Radiography, Dementia, Vascular, Nootropic Agents
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