August 26 Highlights

Abstract

Wilkinson et al. studied the effects of the acetylcholinesterase inhibitor donepezil in 616 patients with vascular dementia. At 24 weeks, patients treated with donepezil 5 mg/day or 10 mg/day demonstrated significant benefits vs placebo in both cognition and global function. see page 479 Commentary by Martin Farlow, MD The prevalence of vascular dementia (VaD) ranks only behind that of Alzheimer’s disease (AD), but no therapies until now have been established to delay disease progression or improve cognitive symptoms. The pattern of progression differs from AD, in that cognitive decline in VaD as defined by National Institute of Neurological Disorders and Stroke–Association Internationale pour la Recherche en l’Enseignement en Neurosciences criteria typically occurs in sharp drops that may be associated with strokes rather than the steady decline more typically seen in AD. In a clinical trial setting, where patients with VaD may more regularly receive therapy for vascular risk factors, there may be no decline in cognitive functioning. In the double-blind, placebo-controlled trial of two doses of donepezil reported in this issue of Neurology by Wilkinson et al., exactly this result was seen, as illustrated in the figure, with the placebo group actually slightly improved versus baseline on AD Assessment Scale–Cognitive Subscale scores. This absence of progression creates a higher …