Donepezil may reduce the risk of comorbidities in patients with Alzheimer's disease: A large-scale matched case-control analysis in Japan

Cognitive Function, and Its Relationships with Comorbidities, Physical Activity, and Muscular Strength in Korean Older Adults

Background: Little is known regarding how much physical activity (PA) and lower-body muscle strength (LBMS) together can help to reduce the negative effect of comorbidities on cognitive function. This study examined the moderating effects of PA and LBMS in determining the relationship between comorbidities and cognitive function in older Korean adults. Materials and Methods: This is a population-based cross-sectional study. Data for this study were taken from the 2020 Korea Longitudinal Study on Aging (KLoSA) in South Korea using a computer-assisted personal interview. The 2020 KLoSA survey included a total of 10,097 older individuals aged 65 and older (6062 females and 4035 men). Comorbidities were determined based on physician-diagnosed chronic conditions. PA and LBMS were measured with a self-reported questionnaire and a sit-to-stand test, respectively. Cognitive function was assessed using the Korean version of the Mini-Mental Status Examination for dementia screening. Results: Multimorbidity was correlated with an increased risk (odds ratio, OR = 1.415, p < 0.001) of cognitive impairment. Insufficient PA and weak LBMS were correlated with an increased risk of cognitive impairment (OR = 1.340, p < 0.001; OR = 1.719, p < 0.001, respectively). Particularly, PA modulates the negative impact of comorbidities on cognitive function (β = −0.3833; 95% CI = −0.4743 to −0.2023) independent of all measured covariates. Weak LBMS was found to be an independent predictor of cognitive function (β = −2.5078, p < 0.001) regardless of comorbidities. Conclusions: The study findings suggest that a lifestyle intervention targeting regular PA and muscular fitness should be a therapeutic means against cognitive decline associated with normal aging and/or chronic diseases.

Investigation of the gait parameters after donepezil treatment in patients with alzheimer' s disease

INTRODUCTION

Clinical studies remark that gait disturbance is common in patients with Alzheimer's disease (AD). However, the treatment response of gait disturbance in those patients may constitute a more interesting issue that is rarely addressed.

METHODS

In this prospective, interventional study, we included 14 consecutive patients with a new diagnosis of AD. Basal gait analysis was performed using a 'Gait Analyzer' program that was uploaded to a mobile phone. The gait parameters including Step time (ST), step length (SL), step number (SN), gait velocity (GV), and cadence were measured. Afterward, donepezil 5 mg daily was initiated, and the re-assessments were re-performed 8 weeks after the treatment.

RESULTS

The mean age was 71.78 ± 5.02 (F/M = 8/6). The evaluations after the donepezil treatment showed that there was a significant improvement in the SN (p = 0.021) and SL (p = 0.001) in comparison to the basal evaluations. The repeated analysis in the subgroup of early-stage AD subjects (n = 10) yielded that there were significant improvements in SN (p = 0.003), SL (p = 0.005), and cadence (p = 0.026) after treatment.

CONCLUSIONS

Our results support the efficiency of cholinergic treatment in gait functions in AD subjects.

Effect of Psychoeducational Intervention on Donepezil Retention Rate and Analysis of Reasons for the Discontinuation in Patients with Alzheimer's Dementia: A Randomized Study

PURPOSE

Medication discontinuation for patients with Alzheimer's dementia (AD) influences treatment efficacy. This study aimed to evaluate the effect of psychoeducational intervention (PI) on donepezil retention rates and identify the factors associated with donepezil continuation in patients with AD.

PATIENTS AND METHODS

One hundred and seventeen patients with AD were randomly allocated to the PI (n = 58) or standard care (SC; n = 59) groups. All patients were prescribed donepezil for 48 weeks. Primary endpoints were the 48-week donepezil retention rate and the reasons for donepezil discontinuation in the PI and SC groups. The secondary endpoint was the predictive factors, among the baseline clinical variables, for donepezil continuation in all patients.

RESULTS

The donepezil retention rate was 62.1% (36/58) in the PI group and 66.1% (39/59) in the SC group. The most common reason for discontinuation in both groups was adverse events (PI, 12.1%; SC, 10.2%). Logistic regression analysis revealed that the results of the pentagon copying test in the Mini-Mental State Examination administered at baseline was a significant predictor of donepezil continuation for all patients in both the groups (odds ratio: 0.359; 95% confidence interval: 0.154-0.839).

CONCLUSION

There was no significant difference between the PI and SC groups concerning donepezil retention rate in patients with AD. Our results demonstrate that the pentagon copying test can significantly predict donepezil continuation in patients with AD, indicating that impaired visuospatial and executive functions may reflect medication discontinuation.

TRIAL REGISTRATION

UMIN-CTR:UMIN000012617.