Abstract
The efficacy of donepezil is well known for improving the cognitive performance in patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD). Most of the recent neuroimaging studies focusing on the brain morphometry have dealt with the targeted brain structures, and thus it remains unknown how donepezil treatment influences the volume change over the whole brain areas including the cortical and subcortical regions and hippocampal subfields in particular. This study aimed to evaluate overall gray matter (GM) volume changes after donepezil treatment in MCI, which is a prodromal phase of AD, using voxel-based morphometry. Patients with MCI underwent the magnetic resonance imaging (MRI) before and after 6-month donepezil treatment. The cognitive function for MCI was evaluated using the questionnaires of the Korean version of the mini-mental state examination (K-MMSE) and Alzheimer’s disease assessment scale-cognitive subscale (ADAS-Cog). Compared with healthy controls, patients with MCI showed significantly lower GM volumes in the hippocampus and its subfields, specifically in the right subiculum and left cornu ammonis (CA3). The average scores of K-MMSE in patients with MCI improved by 8% after donepezil treatment. Treated patients showed significantly higher GM volumes in the putamen, globus pailldus, and inferior frontal gyrus after donepezil treatment (p < 0.001). However, whole hippocampal volume in the patients decreased by 0.6% after 6-month treatment, and the rate of volume change in the left hippocampus was negatively correlated with the period of treatment. These findings will be useful for screening and tracking MCI, as well as understanding of the pathogenesis of MCI in connection with brain morphometric change.
Highlights
The efficacy of donepezil is well known for improving the cognitive performance in patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD)
We found a significant difference in the Korean version of the mini-mental state examination (K-MMSE) (p = 0.031) between untreated patients and donepezil-treated patients, in which the average scores were improved following donepezil treatment
It should be noted that the average scores on the ADAS-Cog in untreated and donepezil-treated patients were 25.3 ± 8.0 and 25.1 ± 6.1, respectively (p = 0.759, NS); the average scores on the Clinical Dementia Rating (CDR) in both groups were 0.7 ± 0.2 and 0.6 ± 0.2, respectively (p = 0.157, NS) and the scores on the geriatric depression scale (GDS) were 13.0 ± 5.0 and 12.6 ± 4.8, respectively (p = 0.370, NS) (Table 1)
Summary
The efficacy of donepezil is well known for improving the cognitive performance in patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD). Whole hippocampal volume in the patients decreased by 0.6% after 6-month treatment, and the rate of volume change in the left hippocampus was negatively correlated with the period of treatment. These findings will be useful for screening and tracking MCI, as well as understanding of the pathogenesis of MCI in connection with brain morphometric change. Treatment of patients with MCI with AChEIs prevents the breakdown of ACh and increases cholinergic transmission, leading to the amelioration of symptoms. Wang et al.[15] has suggested that donepezil treatment did not affect the hippocampal volume change in mild AD
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