Donepezil improves cognition in brain tumor patients

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Treatment with the acetylcholinesterase inhibitor donepezil leads to significant improvement in cognitive function and quality of life in patients who have undergone radiotherapy for brain tumors, according to findings of a phase II, open-label trial.

Brain tumors and their treatment, including radiation therapy, lead to cognitive impairment in many patients, Dr. Stephen R. Rapp and colleagues at Wake Forest University School of Medicine, Chapel Hill, North Carolina point out.

The researchers hypothesized that radiation may cause neuronal injury that leads to acetylcholine deficiency. Therefore donepezil, an agent approved for Alzheimer's disease dementia, may have a therapeutic effect by increasing acetylcholine levels.

To investigate, the team treated patients, who had undergone radiation therapy for a brain tumor, with donepezil 5 mg per day for 6 weeks and then 10 mg per day for another 18 weeks. The findings are published in the March 20th issue of the Journal of Clinical Oncology.

Twenty-four patients, most of whom had low-grade gliomas, completed the study. They were significantly improved from baseline in measures of attention and concentration and verbal and figural memory. There was also a trend towards increased verbal fluency.

Confusion was reduced and patients also appeared have lower levels of fatigue and anger. Health-related quality of life improved significantly and there was a trend towards improvement in social and emotional functioning.

These findings, senior investigator Dr. Rapp said in a statement, "encourage continued investigation of donepezil and other acetylcholinesterase inhibitors." The researchers are currently planning a double-blind, placebo-controlled trial "to confirm these favorable results."