Cholinesterase inhibitors for vascular dementia and other VCI¶

One-paragraph summary¶

Eight trials/4,373 participants showed small cognitive-scale benefits for donepezil 5 mg (ADAS-Cog MD −0.92, 95% CI −1.44 to −0.40), donepezil 10 mg (−2.21, −3.07 to −1.35), and galantamine 16–24 mg (−2.01, −3.18 to −0.85); the review judged these effects unlikely to be clinically important. Rivastigmine 3–12 mg was uncertain (MD 0.03, −3.04 to 3.10). Donepezil 10 mg and galantamine increased adverse events (OR 1.95, 1.20–3.15; OR 1.57, 1.02–2.43) (Battle 2021, PMID 33704781). Search date 19 August 2020.

Key findings¶

Donepezil 10 mg had the largest cognitive estimate.
Donepezil 10 mg increased adverse events: OR 1.95 (1.20–3.15).
Galantamine adverse-event OR was 1.57 (1.02–2.43).
Function/global effects were less consistent than cognition.

Limitations¶

Older clinical criteria did not separate mixed Alzheimer disease well.
Trial duration was short for vascular progression.
Mean scale change does not identify individual meaningful response.

Why it matters¶

It quantifies the treatment tradeoff that guidelines describe variably.

Cited by wiki pages¶

Treatment
Guidelines