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Randomized double-blind placebo-controlled donepezil augmentation in antidepressant-treated elderly patients with depression and cognitive impairment: a pilot study

✍ Scribed by Gregory H. Pelton; Oliver L. Harper; Matthias H. Tabert; Harold A. Sackeim; Nikolaos Scarmeas; Steven P. Roose; D. P. Devanand

Publisher
John Wiley and Sons
Year
2008
Tongue
English
Weight
97 KB
Volume
23
Category
Article
ISSN
0885-6230

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✦ Synopsis

Abstract

Objective

To assess combined antidepressant and cognitive enhancer treatment in elderly patients presenting with depression plus cognitive impairment.

Methods

Twenty‐three elderly (>50 years old) depressed, cognitively impaired (DEP‐CI) patients participated in a pilot study. We evaluated whether, after 8 weeks of open antidepressant treatment, donepezil HCl (Aricept) would afford added cognitive benefit compared to placebo in a randomized 12‐week trial. A subsample continued in an 8‐month extension phase of open treatment with donepezil. Neuropsychological testing (NPT) was performed and antidepressant response monitored at baseline and the 8, 20, and 52‐week time points.

Results

At 8‐weeks, the antidepressant response rate was 61% (14/23). Improvement in SRT immediate recall (SRT‐IR; e.g. episodic verbal memory) was observed in responders compared to non‐responders. During the 12‐week, placebo‐controlled, donepezil add‐on trial, patients on donepezil showed further improvement in SRT‐IR versus patients on placebo. In the open extension phase, patients who continued open donepezil treatment (n = 6) maintained improvement in memory and tended to show an advantage over patients who never received donepezil and were evaluated at the 52‐week time point (n = 6). There were no observed significant donepezil effects on non‐memory cognitive domains.

Conclusion

These preliminary findings suggest that addition of a cholinesterase inhibitor (AChEI) following antidepressant medication treatment in elderly Dep‐CI patients may improve cognition, and support the need for a confirmatory, larger randomized placebo‐controlled trial. Copyright © 2007 John Wiley & Sons, Ltd.

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