Beneficial effect of donepezil augmentation for the management of Comorbid schizophrenia and dementia

• Published in: Clinical neuropharmacology Vol. 26; no. 1; pp. 12 - 17
• Main Authors: STRYJER, Rafael, STROUS, Rael D, BAR, Faina, WERBER, Edith, SHAKED, Ginette, BUHIRI, Yosef, KOTLER, Moshe, WEIZMAN, Abraham, RABEY, Jose M
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01-01-2003
• Subjects: Aged; Biological and medical sciences; Cholinesterase Inhibitors - adverse effects; Cholinesterase Inhibitors - therapeutic use; Dementia - complications; Dementia - drug therapy; Drug Therapy, Combination; Female; Humans; Indans - adverse effects; Indans - therapeutic use; Male; Medical sciences; Middle Aged; Neuropharmacology; Nootropic Agents - adverse effects; Nootropic Agents - therapeutic use; Pharmacology. Drug treatments; Piperidines - adverse effects; Piperidines - therapeutic use; Psychiatric Status Rating Scales; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Schizophrenia - complications; Schizophrenia - drug therapy; Schizophrenic Psychology; Single-Blind Method; Treatment Outcome; Human; Nervous system diseases; Enzyme; Psychotropic; Enzyme inhibitor; Schizophrenia; Esterases; Schizophrenia-Dementia-Donepezil; Cholinesterase; Carboxylic ester hydrolases; Cerebral disorder; Psychosis; Concomitant disease; Chemotherapy; Treatment; Donepezil; Nootropic agent; Central nervous system disease; Piperidine derivatives; Hydrolases; Degenerative disease; Presenile dementia; Anticholinesterase agent
• ISSN: 0362-5664; 1537-162X
• DOI: 10.1097/00002826-200301000-00004

Comorbid schizophrenia and dementia is a common clinical phenomenon; however, management of the coexisting illnesses remains incomplete. Donepezil, a cholinesterase inhibitor, may be beneficial for the management of symptoms of Alzheimer's disease, a disease in which cholinergic pathways in the cerebral cortex and basal forebrain are well known to be compromised. Furthermore, impaired cognition in elderly schizophrenic patients has been observed to be more than two thirds; however, there are no published controlled studies reporting the use of cholinesterase inhibitors in the management of schizophrenia in patients with associated dementia. In this study, six patients with chronic schizophrenia and comorbid dementia were administered donepezil, 5 mg, in single-blind fashion as augmentation to their standard antipsychotic medication for a 4-week period. Patients were evaluated with the Mini Mental State Examination (MMSE); Alzheimer's Disease Assessment Scale, Cognitive subscale; Positive and Negative Symptom Scale (PANSS); and the Clinical Global Impression (CGI) scales. A significant improvement was noted in MMSE scores (P < 0.01) and for CGI scores (P < 0.01). In addition, three patients demonstrated improvement on the PANSS. Donepezil appears to be an effective treatment for the management of symptoms of dementia accompanying patients with comorbid schizophrenia and dementia. Since cholinergic dysfunction may be present in some patients with schizophrenia, the authors' findings further demonstrate the possibility that this disorder may be managed with cholinergic medications as augmenting agents, at least in this specific subpopulation of patients with comorbid dementia. To confirm the findings of this preliminary trial, further investigation is mandated with a larger sample of subjects in the context of a double-blind medication trial.