According to an article published in the April edition of The Lancet Neurology, donepezil may improve the executive function of patients who suffer from the CADASIL form of vascular dementia. CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) is a genetic form of vascular dementia (due to vascular lesions in the brain) and the most common form of hereditary stroke disorder. It tends to begin with migraine headaches and strokes in middle-aged patients. Executive functions are the high-level cognitive processes that facilitate new ways of behaving, and optimize one's approach to unfamiliar circumstances.
Donepezil is a type of cholinesterase inhibitor (CI) that can benefit functions of brain, body, and daily living activities in patients with mild to moderate Alzheimer's disease (AD). In the elderly, it is quite common to have AD along with vascular dementia. One of the difficulties in testing CI drugs is due to the fact that it is not clear whether the drug benefits have been caused by improvement in the vascular dementia or the AD. Since CADASIL has early onset in patients, it is possible to study people who only have CADASIL, without overlapping AD symptoms. Dichgans and colleagues studied 168 patients in randomized controlled setting, all who had CADASIL and were between 25 and 70 years of age. The focus was to see if donepezil improved cognitive function. Over 18 weeks, 86 participants received 10 mg donepezil each day and 82 received placebo. Donepezil resulted in a significant treatment improvement in a number of secondary outcomes such as: The times taken to perform specific tasks (TMT B time and TMT A time) and an executive cognitive function assessment (EXIT25 - a 25-item interview scored between 0 and 50). The Lancet Neurology. February 22, 2008.
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