Authors' objectives:

Donepezil is a new drug treatment, recently licensed in the UK, for use in mild to moderate dementia due to senile dementia of the Alzheimer type (SDAT). The author assesses whether it should be made available to all patients with mild to moderate SDAT.

Authors' results and conclusions: The RCTs of donepezil show statistically significant differences between treatment and placebo groups in ADAS-cog scores. Mean change over baseline was between 2.5 and 3.2 points better in the subjects on treatment: the overall rate of cognitive decline in SDAT is probably between 6 and 12 ADAS-cog points per year.

Authors' recommendations: The effectiveness of donepezil in routine clinical practice remains uncertain, and the external validity of the clinical trials to date is, necessarily, limited. It is not clear how response to treatment should be measured in routine practice, although dose escalation and continuation of treatment will demand accurate assessment. It may be argued that the size of benefits is so small that the risk of greater side effects in more typical people with SDAT, many of whom have co-morbidity and may already be on other drugs, make it difficult to conclude on overall effectiveness. Evidence is limited in quantity and by restriction to select population. The author concludes that there is evidence of temporary benefit but at considerable cost. Further research is needed in this area.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.wihrd.soton.ac.uk

Year Published: 1997

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: Wessex Institute for Health Research and Development

Contact Address: Pauline King. Wessex Institute for Health Research and Development, Boldrewood Medical School, Bassett Crescent East, Highfield, Southampton. SO16 7PX Tel. +44 1703 595661 Fax +44 1703 595662

Copyright: Wessex Institute for Health Research and Development (WIHRD)