Donepezil (Aricept—a potent acetylcholin-esterase inhibitor) had small effects on mentation for patients with mild to moderate vascular dementia as measured by validated instruments of cognition.
Donepezil’s side effects are similar to placebo at 5 mg but double at 10 mg, with no improvement in the patient’s cognition. Even though this medication was minimally effective, there are no other highly effective medical treatments for vascular dementia. Therefore, if a patient chooses a trial of donepezil, the lower, 5-mg dose should be offered.
The medication’s effect is likely a class effect and not an individual drug effect; therefore, rivastigmine (Exelon) and galantamine(Reminyl) are 2 other acetylcholinesterase inhibitors that should also be considered. Cost is similar for all 3 drugs at about $130.00 per month.