Use combination of quetiapine and donepezil in the treatment of dementia in elderly patients Review article
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Abstract
The goals of the treatment of dementia is to slow down the progression of neurological changes and reduce the severity of symptoms. One of the early symptoms of the development of neurological diseases is late-onset depression, which is associated with impaired functioning of the prefrontal circuits, prefrontal-striatal dysfunction, which is responsible for cognitive-depressive dysfunction. This syndrome responds poorly to antidepressants and better to dopaminergic drugs. Based on the literature and clinical experience, we can conclude that the combination of donepezil and quetiapine may provide many benefits to patients with dementia and is well tolerated. Cholinesterase inhibitors (i.e. donepezil) have the best proven effect in the first stage of the disease, when cholinergic deficiency is most prevalent, and benefit from 30–50% of patients. Quetiapine has a lower potential for developing weight gain and metabolic complications, and for producing hyperprolactinaemia and extrapyramidal symptoms, and is better tolerated.
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References
2. Siwek M, Wierzbiński P. Kompendium wiedzy o kwetiapinie i nie tylko. Wydawnictwo Lekarskie PZWL, Warszawa 2019.
3. Taylor MD, Barnes TRE, Young A. The Maudlsey Prescribing Guidelines in Psychiatry. 13th ed. Wiley-Black-well 2018.
4. Seltzer B, Zolnouni P, Nunez M et al; Donepezil “402” Study Group. Efficacy of donepezil in early-stage Alzheimer disease: a randomized placebo- controlled trial. Arch Neurol. 2004; 61(12):1852-6. https://doi.org/10.1001/archneur.61.12.1852.
5. Wojtera M, Sobów T. Farmakoterapia choroby Alzheimera i innych otępień w praktyce: który lek, kiedy i dla kogo? Aktualn Neurol. 2014;14(4): 218-27.
6. Lee J-H, Jeong S-K, Kim BC et al. Donepezil across the spectrum of Alzheimer’s disease: dose optimization and clinical relevance. Acta Neurol Scand. 2015; 131(5): 259-65. https://doi.org/10.1111/ane.12386.
7. Rogers SL, Doody RS, Mohs RC et al; Donepezil Study Group. Donepezil improves cognition and global function in Alzheimer disease: a 15-week, double-blind, placebo-controlled study. Arch Intern Med. 1998; 158(9): 1021-31. https://doi.org/10.1001/archinte.158.9.1021.
8. Petersen RC, Thomas RG, Grundman M et al. Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med. 2005; 352: 2379-88.
9. Winblad B, Engedal K, Soininen H et al. A 1-year, randomized, placebo-controlled study of donepezil in patients with mild to moderate AD. Neurology. 2001; 57: 489-95.
10. Doody RS, Geldmacher DS, Gordon B et al. Open-label, multicenter, phase 3 extension study of the safety and efficacy of donepezil in patients with Alzheimer disease. Arch Neurol. 2001; 58: 427-33.
11. Isik AT, Yildiz BG, Bozoglu E et al. Cardiac Safety of Donepezil in Elderly Patients with Alzheimer Disease. Int Med. 2012; 51(6): 575-8.
12. Farlow MR, Hake A, Messina J et al. Response of patients with Alzheimer disease to rivastigmine treatment is predicted by the rate of disease progression. Arch Neurol. 2001; 58(3): 417-22. https://doi.org/10.1001/archneur.58.3.417 .
13. Farlow MR, Lilly ML; and for the ENA713 B352 Study Group. Rivastigmine: an open-label, observational study of safety and effectiveness in treating patients with Alzheimer’s disease for up to 5 years. BMC Geriatr. 2005; 5: 3. https://doi.org/10.1186/1471-2318-5-3.
14. Touchon J, Bergman H, Bullock R et al. Response torivastigmine or donepezil in Alzheimer’s patients with symp-toms suggestive of concomitant Lewy body pathology. Curr Med Res Opin. 2006; 22: 49-59.
15. Birks J, Evans JG, Iakovidou V et al. Rivastigmine for Alzheimer’s disease. Cochrane Database Syst Rev. 2009; (2): CD001191. https://doi.org/10.1002/14651858.CD001191.pub2.
16. Morganroth J, Graham S, Hartman R et al. Electrocardiographic Effects of Rivastigmine. The J Clin Pharmacol. 2002; 42(5): 558-68.
17. Lopez OL, Becker JT, Wahed AS et al. Long-term effects of the concomitant use of memantine with cholinesterase inhibition in Alzheimer disease. J Neurol Psychiatry. 2009; 80: 600-7. https://doi.org/ 10.1136/jnnp.2008.158964.
18. Kales HC, Kim HM, Zivin K et al. Risk of mortality among individual antipsychotics in patients with dementia. Am J Psychiatry. 2012; 169(1): 71-9.