Donepezil Seen to Aid Cognition, Life Quality for MS Patients in Small Trial

Donepezil — an approved treatment for Alzheimer’s disease — eased cognitive impairment, depression, and improved other quality-of-life measures in multiple sclerosis (MS) patients with mild to moderate disability, according to results of a single-site clinical trial.

The study, “Effect of Donepezil on Cognitive Impairment, Quality of Life, and Depression in Multiple Sclerosis Patients: A Randomized Clinical Trial,” was published in the International Journal of Preventive Medicine.

Chronic inflammation of the central nervous system — the brain and spinal cord — plays a role in the physical and cognitive declines experienced by people with MS. Roughly half of all MS patients show cognitive impairments that affect their well being and life quality.

At present, no therapy has been approved specifically to treat cognitive difficulties in MS.

Donepezil, sold under the brand name Aricept (by Eisai) to treat cognitive problems due to Alzheimer’s, has shown some evidence of being able to aid cognition and ease depression among MS patients.

A team led by researchers at Isfahan University of Medical Sciences in Iran opened a randomized trial to assess the efficacy of donepezil in treating MS patients with mild to moderate cognitive dysfunction, as well as its possible effects on depression and quality of life.

Their study evaluated 100 adults, with an average age of 31, referred to an affiliated outpatient clinic. Patients’ extended disability status scale (EDSS) scores were an average of 2.71 for those assigned to treatment and 2.58 for those placed in a placebo group, indicating mild to moderate disability without walking impairment.

Half of these adults, 50 patients, would be given donepezil at 10 mg daily and the other half a placebo for three months.

Prior to treatment, researchers evaluated patients’ working memory and cognitive abilities using the abbreviated mental test (AMT), prospective and retrospective mental questionnaire (PRMQ), the everyday memory questionnaire (EMQ), and the digit span test.

Depression and quality-of-life measures were assessed using the Beck depression inventory and the MSQOL questionnaire.

These evaluations were conducted again three months later, at the end of treatment, with the 50 patients remaining in each group.

MS patients taking donepezil showed significant improvements across all scores, as compared with the placebo group, which showed no statistically significant change.

Scores on the EMQ and PRMQ questionnaires and digit span tests of memory and cognition, as well as those of the physical and mental health questionnaire MSQOL and the Beck depression inventory all significantly improved in patients using donepezil, results showed.

“Donepezil could successfully improve different components of cognitive function, including daily memory, retrospective and prospective memory, and attention. Moreover, it improves depression as well as both physical and mental QOL [quality of life],” the researchers wrote.

No patient reported missing their medication throughout the study, and reported adverse events were mostly mild. These included nausea, diarrhea, and headaches that resolved in about a week.

Although this was a relatively short study that lacked long-term follow-up, the researchers suggested its results point toward a potential benefit for donepezil in MS.

“Based on our findings, donepezil could successfully improve different components of cognitive function, including daily memory, retrospective and prospective memory, and attention. Moreover, it improves depression as well as both physical and mental QOL,” they wrote.

“It seems that the earlier initiation of donepezil for patients in the early steps of cognitive dysfunctions can help lessen the severity and decelerate the progression of cognition impairment,” the researchers added, recommending further studies in larger patient groups and with longer follow-up.