Donepezil for Balance/gait

patient prescription for donepezil for "balance & gait"

• Reversible cholinesterase inhibitor --> increased concentration of acetylcholine
• approved for dementia/Alzheimers
• The degeneration of cholinergic systems may contribute to impairments in gait and balance
• adverse effects: diarrhea, nausea, vomiting, muscle cramps, insomnia, fatigue .
• due to cholinergic effects, it is hypothesized that treatment with donepezil should improve balance and gait, so far studied in Parkinson's disease
• Randomized, double-blind cross over trial compared donepezil x 6 weeks 10 mg max per day with 3 week washout period in subjects with Parkinson's disease who fall more than 2 times per week
• primary outcomes: daily falls 
• treatment with donepezil reduced falls by half compared to placebo
• small sample size: 23 subjects

Studies currently ongoing to evaluate cholinergic augmentation for balance and gait:

• Randomized, double-blind cross over trial compared donepezil 2.5 mg 2/day x 3 weeks then 4/day for 6 weeks with a 6 week washout period between treatment periods in subjects with Parkinson's disease 
• primary outcome: root mean square of mediolateral sway when standing and variability of stride duration when walking two minutes
• Randomized, double-blind, placebo controlled trial will compare donepezil to placebo in older adults with cognitive problems (subjects in early stages of dementia -- NOT Parkinson's disease)
• primary outcomes: improvements in gait velocity, reduction in gait variability
• hypothesis -- donepezil will be effective for fall prevention in older adults with cognitive impairments