Donepezil for mild and moderate Alzheimer's disease.


BACKGROUND:Alzheimer's disease is the most common cause of dementia and is a primary degenerative disease of the brain of unknown cause. Onset is usually late in life with increasing impairment of memory, developing gradually into a global impairment of cognition, orientation, linguistic ability and judgement. The clinical course is accompanied by growing disability and dependency on care. One of the characteristic features of the disease is the widely variable rate of progression seen in different patients. Acetylcholine is an important neurotransmitter associated with memory, and abnormalities in cholinergic neurones (including cell loss) are among the many neurological and neurochemical abnormalities that develop in AD. One approach to lessening the impact of these abnormalities is to inhibit the breakdown of acetylcholine by blocking the relevant enzyme. Tacrine was the first compound approved as a treatment for AD in the US and worked in this way, but caused severe side effects. E2020 (donepezil, Aricept) is a second generation cholinesterase inhibitor and appears to be highly specific, with relatively few side effects. OBJECTIVES:The objective of this review is to assess whether or not donepezil improves the well-being of patients with mild or moderate Alzheimer's disease. SEARCH STRATEGY:The Cochrane Dementia and Cognitive Impairment Group Register of Clinical Trials, was searched using the terms 'donepezil', 'E2020' and 'ARICEPT'. Medline, PsychLIT and EMBASE electronic databases were searched with the above terms. Members of the Donepezil Study Group and Eisai Inc were contacted. SELECTION CRITERIA:All unconfounded, double-blind, randomised controlled trials in which treatment with donepezil was administered for more than a day and compared with placebo in patients with Alzheimer's disease. DATA COLLECTION AND ANALYSIS:Data were extracted independently by the reviewers (JSB & DB), pooled where appropriate and possible, and the weighted or standardised mean differences or Peto odds ratios (95%CI) estimated. Where possible, intention-to-treat data were used. MAIN RESULTS:There are 4 included trials, covering treatment of 12 or 24 weeks duration in highly selected patients. The only information available on one trial (Gauthier 1998) is a conference abstract which reports no usable results. Available outcome data cover domains including cognitive function and global clinical state, but data on several important dimensions of outcome are not available. The results of three trials suggest a small beneficial effect of donepezil in improving cognitive function: at a 5mg/day dose, improvements measured -2.6 points (95%CI -3.5 -- -1.8) on weighted mean difference, in the midrange of the 70 point ADAS-Cog scale. The results of two trials show some improvement in global clinical state (assessed by an independent clinician) in those treated with donepezil compared to placebo. The patient's own rating of their Quality of Life showed no benefit of donepezil compared with placebo. There were significantly more withdrawals before the end of treatment from the 10mg/d (but not the 5mg/d) donepezil group compared with placebo, which may have resulted in some overestimation of beneficial changes at 10mg/d in progressively declining characteristics, as last available measures were used in analyses. A variety of adverse effects were recorded, but very few patients left a trial as a direct result of the intervention. REVIEWER'S CONCLUSIONS:In selected patients with mild or moderate Alzheimer's disease treated for periods of 12 or 24 weeks, donepezil produced modest improvements in cognitive function and study clinicians rated global clinical state more positively in treated patients. No improvements were present on patient self-assessed quality of life and data on many important outcomes are not available. The practical importance of these changes to patients and carers is unclear.


Birks J S,Melzer D





Has Abstract


2000-01-01 00:00:00










  • Aldose reductase inhibitors for the prevention and treatment of diabetic peripheral neuropathy.

    abstract:OBJECTIVES:To assess the efficacy of aldose reductase inhibitors in the prevention, reversal or delay in the progression of diabetic peripheral neuropathy. SEARCH STRATEGY:The Cochrane Diabetes Group's database was searched and the citation lists of identified trials and previous reviews checked. Investigators identif...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Airey M,Bennett C,Nicolucci A,Williams R

    更新日期:2000-01-01 00:00:00

  • Medical and surgical interventions for the treatment of usual-type vulval intraepithelial neoplasia.

    abstract:BACKGROUND:Usual-type vulval intraepithelial neoplasia (uVIN) is a pre-cancerous condition of the vulval skin. Also known as high-grade VIN, VIN 2/3 or high-grade vulval squamous intraepithelial lesion (HSIL), uVIN is associated with high-risk subtype human papilloma virus (HPV) infection. The condition causes distress...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Lawrie TA,Nordin A,Chakrabarti M,Bryant A,Kaushik S,Pepas L

    更新日期:2016-01-05 00:00:00

  • Buprenorphine for the management of opioid withdrawal.

    abstract:BACKGROUND:Managed withdrawal is a necessary step prior to drug-free treatment or as the end point of substitution treatment. OBJECTIVES:To assess the effectiveness of interventions involving the use of buprenorphine to manage opioid withdrawal, for withdrawal signs and symptoms, completion of withdrawal and adverse e...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Gowing L,Ali R,White JM

    更新日期:2009-07-08 00:00:00

  • Calcium channel blockers for preventing acute tubular necrosis in kidney transplant recipients.

    abstract:BACKGROUND:The incidence of delayed graft function in cadaveric grafts has increased over the last few years due in part to the large demand for cadaveric kidneys necessitating the use of kidneys from marginal donors. Calcium channel blockers have the potential to reduce the incidence of post-transplant acute tubular n...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Shilliday IR,Sherif M

    更新日期:2007-10-17 00:00:00

  • Automated monitoring compared to standard care for the early detection of sepsis in critically ill patients.

    abstract:BACKGROUND:Sepsis is a life-threatening condition that is usually diagnosed when a patient has a suspected or documented infection, and meets two or more criteria for systemic inflammatory response syndrome (SIRS). The incidence of sepsis is higher among people admitted to critical care settings such as the intensive c...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Warttig S,Alderson P,Evans DJ,Lewis SR,Kourbeti IS,Smith AF

    更新日期:2018-06-25 00:00:00

  • Zonisamide add-on therapy for focal epilepsy.

    abstract:BACKGROUND:The majority of people with epilepsy have a good prognosis, and their seizures can be well controlled with the use of a single antiepileptic agent, but up to 30% develop refractory epilepsy, especially those with focal seizures. In this review, we summarised the evidence from randomised controlled trials (RC...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析


    authors: Brigo F,Lattanzi S,Igwe SC,Behzadifar M,Bragazzi NL

    更新日期:2018-10-18 00:00:00

  • Non-pharmaceutical measures for prevention of post-thrombotic syndrome.

    abstract:BACKGROUND:Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) characterised by chronic pain, swelling and skin changes in the affected limb. One in every three patients with DVT will develop post-thrombotic complications within five years. OBJECTIVES:To determine the relative effe...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Kolbach DN,Sandbrink MW,Hamulyak K,Neumann HA,Prins MH

    更新日期:2004-01-01 00:00:00

  • Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries.

    abstract:BACKGROUND:Dental caries is one of the most common chronic diseases of childhood and is associated with adverse health and economic consequences for infants and their families. Socioeconomically disadvantaged children have a higher risk of early childhood caries (ECC). OBJECTIVES:To assess the effects of interventions...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析


    authors: Riggs E,Kilpatrick N,Slack-Smith L,Chadwick B,Yelland J,Muthu MS,Gomersall JC

    更新日期:2019-11-20 00:00:00

  • Surgery versus medical therapy for heavy menstrual bleeding.

    abstract:BACKGROUND:Heavy menstrual bleeding significantly impairs the quality of life of many otherwise healthy women. Perception of heavy menstrual bleeding is subjective and management usually depends upon what symptoms are acceptable to the individual. Surgical options include conservative surgery (uterine resection or abla...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Marjoribanks J,Lethaby A,Farquhar C

    更新日期:2016-01-29 00:00:00

  • Touch therapies for pain relief in adults.

    abstract:BACKGROUND:Pain is a global public health problem affecting the lives of large numbers of patients and their families. Touch therapies (Healing Touch (HT), Therapeutic Touch (TT) and Reiki) have been found to relieve pain, but some reviews have suggested there is insufficient evidence to support their use. OBJECTIVES:...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: So PS,Jiang Y,Qin Y

    更新日期:2008-10-08 00:00:00

  • Interventions for preventing bone disease in kidney transplant recipients.

    abstract:BACKGROUND:Patients with chronic kidney disease have significant abnormalities of bone remodelling and calcium homeostasis and are at increased risk of fracture. The fracture risk for a kidney transplant recipient is four times that of the general population and higher than that for a patient on dialysis. Trials report...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Palmer S,McGregor DO,Strippoli GF

    更新日期:2005-04-18 00:00:00

  • Continuous glucose monitoring systems for type 1 diabetes mellitus.

    abstract:BACKGROUND:Self-monitoring of blood glucose is essential to optimise glycaemic control in type 1 diabetes mellitus. Continuous glucose monitoring (CGM) systems measure interstitial fluid glucose levels to provide semi-continuous information about glucose levels, which identifies fluctuations that would not have been id...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Langendam M,Luijf YM,Hooft L,Devries JH,Mudde AH,Scholten RJ

    更新日期:2012-01-18 00:00:00

  • Psychological interventions to foster resilience in healthcare professionals.

    abstract:BACKGROUND:Resilience can be defined as the maintenance or quick recovery of mental health during or after periods of stressor exposure, which may result from a potentially traumatising event, challenging life circumstances, a critical life transition phase, or physical illness. Healthcare professionals, such as nurses...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析


    authors: Kunzler AM,Helmreich I,Chmitorz A,König J,Binder H,Wessa M,Lieb K

    更新日期:2020-07-05 00:00:00

  • Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants.

    abstract:BACKGROUND:Indomethacin is used as standard therapy to close a patent ductus arteriosus (PDA) but is associated with reduced blood flow to several organs. Ibuprofen, another cyclo-oxygenase inhibitor, may be as effective as indomethacin with fewer adverse effects. OBJECTIVES:To determine the effectiveness and safety o...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析


    authors: Ohlsson A,Walia R,Shah SS

    更新日期:2020-02-11 00:00:00

  • Interventions for treating scabies.

    abstract:BACKGROUND:Scabies is a common public health problem with an estimated global prevalence of 300 million. Infestation can cause considerable discomfort and intense itching. Severe adverse effects have been reported for some drugs used to treat scabies. OBJECTIVES:The objective of this review is to assess the effects an...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Walker GJ,Johnstone PW

    更新日期:2000-01-01 00:00:00

  • Antibiotic regimens for the empirical treatment of newborn infants with necrotising enterocolitis.

    abstract:BACKGROUND:Although the exact aetiology of necrotising enterocolitis (NEC) remains unknown, research suggests that it is multifactorial; suspected pathophysiological mechanisms include immaturity, intestinal ischaemia, disruption of intestinal mucosal integrity, formula feeding, hyperosmolar load to the intestine, infe...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Shah D,Sinn JK

    更新日期:2012-08-15 00:00:00

  • Botulinum toxin type A therapy for cervical dystonia.

    abstract:BACKGROUND:Cervical dystonia is characterized by involuntary posturing of the head and frequently is associated with neck pain. Disability and social withdrawal are common. In recent years, Botulinum toxin Type A (BtA) has become the first line therapy. However its true efficacy, in particular the potential effect size...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Costa J,Espírito-Santo C,Borges A,Ferreira JJ,Coelho M,Moore P,Sampaio C

    更新日期:2005-01-25 00:00:00

  • Fetal assessment methods for improving neonatal and maternal outcomes in preterm prelabour rupture of membranes.

    abstract:BACKGROUND:Fetal assessment following preterm prelabour rupture of membranes (PPROM) may result in earlier delivery due to earlier detection of fetal compromise. However, early delivery may not always be in the fetal or maternal interest, and the effectiveness of different fetal assessment methods in improving neonatal...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Sharp GC,Stock SJ,Norman JE

    更新日期:2014-10-03 00:00:00

  • Tea tree oil for Demodex blepharitis.

    abstract:BACKGROUND:Demodex blepharitis is a chronic condition commonly associated with recalcitrant dry eye symptoms though many people with Demodex mites are asymptomatic. The primary cause of this condition in humans is two types of Demodex mites: Demodex folliculorum and Demodex brevis. There are varying reports of the prev...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析


    authors: Savla K,Le JT,Pucker AD

    更新日期:2020-06-20 00:00:00

  • Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment.

    abstract:BACKGROUND:Asymptomatic retinal breaks and lattice degeneration are visible lesions that are risk factors for later retinal detachment. Retinal detachments occur when fluid in the vitreous cavity passes through tears or holes in the retina and separates the retina from the underlying retinal pigment epithelium. Creatio...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Wilkinson CP

    更新日期:2014-09-05 00:00:00

  • Interventions for preventing neuropathy caused by cisplatin and related compounds.

    abstract:BACKGROUND:Cisplatin and several related antineoplastic drugs used to treat many types of solid tumours are neurotoxic, and most patients completing a full course of cisplatin chemotherapy develop a clinically detectable sensory neuropathy. Effective neuroprotective therapies have been sought. OBJECTIVES:To examine th...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Albers JW,Chaudhry V,Cavaletti G,Donehower RC

    更新日期:2014-03-31 00:00:00

  • Dietary advice for illness-related malnutrition in adults.

    abstract:BACKGROUND:Illness-related malnutrition has been reported in 10% to 55% of ill people in hospital and the community in areas of food sufficiency. Dietary advice encouraging the use of energy- and nutrient-rich foods rather than oral nutritional supplements has been suggested for managing illness-related malnutrition. ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Baldwin C,Weekes CE

    更新日期:2008-01-23 00:00:00

  • Hormone replacement therapy for women with type 1 diabetes mellitus.

    abstract:BACKGROUND:There is conflicting information about the impact of the menopause on glycaemic control amongst women with type 1 diabetes. Some menopausal women with type 1 diabetes are treated with hormone replacement therapy (HRT) but the effects of this treatment have, to date, not been established. OBJECTIVES:To asses...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Mackay L,Kilbride L,Adamson KA,Chisholm J

    更新日期:2013-06-06 00:00:00

  • Pre-operative chemoradiation for non-metastatic locally advanced rectal cancer.

    abstract:BACKGROUND:This review sets out to assess the efficacy of pre-operative chemoradiation when compared to radiotherapy alone before surgery in the treatment of advanced non metastatic rectal surgery. OBJECTIVES:To determine the efficacy of pre-operative chemoradiation (CRT) compared with radiation (RT) alone, in locally...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: McCarthy K,Pearson K,Fulton R,Hewitt J

    更新日期:2012-12-12 00:00:00

  • Chinese medicinal herbs for sore throat.

    abstract:BACKGROUND:Chinese herbal medicines are commonly used to treat sore throat in China and are used worldwide by practitioners of traditional Chinese medicine (TCM). Their efficacy in treating sore throat has not previously been systematically reviewed. OBJECTIVES:To assess the efficacy and safety of Chinese herbal medic...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Huang Y,Wu T,Zeng L,Li S

    更新日期:2012-03-14 00:00:00

  • Surgical approaches for inserting hemiarthroplasty of the hip.

    abstract:BACKGROUND:The operation of insertion of a hemiarthroplasty to the hip refers to replacement of the femoral head with a prosthesis, whilst retaining the natural acetabulum and acetabular cartilage. The main surgical approaches to the hip for insertion of the prosthesis can be broadly categorised as either 'anterior' vi...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Parker MJ,Pervez H

    更新日期:2002-01-01 00:00:00

  • Supplemental oxygen for the treatment of prethreshold retinopathy of prematurity.

    abstract:BACKGROUND:Oxygen has long been implicated in the pathogenesis of retinopathy of prematurity (ROP) and is rigorously monitored in today's neonatal intensive care units. Recent research using a feline model has shown an improvement in ROP outcome of kittens treated with supplemental oxygen. Current treatment for ROP by ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Lloyd J,Askie L,Smith J,Tarnow-Mordi W

    更新日期:2003-01-01 00:00:00

  • Psychosocial interventions for preventing and treating depression in dialysis patients.

    abstract:BACKGROUND:People with end-stage kidney disease (ESKD) treated with dialysis are frequently affected by major depression. Dialysis patients have prioritised depression as a critically important clinical outcome in nephrology trials. Psychological and social support are potential treatments for depression, although a Co...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析


    authors: Natale P,Palmer SC,Ruospo M,Saglimbene VM,Rabindranath KS,Strippoli GF

    更新日期:2019-12-02 00:00:00

  • Treatments for breast engorgement during lactation.

    abstract:BACKGROUND:Engorgement is the overfilling of breasts with milk, often occurring in the early days postpartum. It results in swollen, hard, painful breasts and may lead to premature cessation of breastfeeding, decreased milk production, cracked nipples and mastitis. Various treatments have been studied but little consis...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章


    authors: Zakarija-Grkovic I,Stewart F

    更新日期:2020-09-18 00:00:00

  • WITHDRAWN: Caesarean delivery for the second twin.

    abstract:BACKGROUND:The optimal mode of birth for a second twin in breech position is controversial, with support for both caesarean and vaginal birth. OBJECTIVES:The objective of this review was to assess the effects of caesarean birth compared with vaginal birth of a second twin not presenting cephalically. SEARCH METHODS:T...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Crowther CA

    更新日期:2011-12-07 00:00:00