By Jenny Powers, DGDispatch

Patients with Parkinson's disease treated with donepezil have as much as a 50-percent reduction in falls, thus enhancing their quality of life, according to researchers at the Movement Disorder Society's (MDS) 13th International Congress of Parkinson's Disease and Movement Disorders.

Kathryn A. Chung, MD, Parkinson Center and Movement Disorders Program, Oregon Health & Science University, Portland, Oregon, presented the findings of a randomized, double-blind, crossover clinical trial of donepezil, here on June 8.

The researchers sought to determine whether treatment with donepezil would decrease the number of falls experienced by patients with PD.

Because anticholinergic medications tend to increase falling frequency in elderly people and cholinergic neuron loss in the central nervous system occurs with PD, the researchers tested whether augmentation of acetylcholine PD would benefit patients who have a history of falling.

Daily fall frequency was the primary endpoint of the study. Additional endpoints were the frequency of near falls; Activities of Balance Confidence (ABC) scale, Unified PD Rating Scale (UPDRS) part III, and Hoehn and Yahr scores; and both investigator- and subject-rated global impression of change at the end of each phase of the study.

The study consisted of a 6-week treatment phase, with donepezil 5 mg QAM for 3 weeks that was increased to 10 mg QAM for 3 weeks, followed by a 3-week washout phase. The study patients then underwent crossover and subsequent medication per the above regimen for another 6-week period. Patients recorded daily fall events on postcards that were sent to and compiled by the research team.

Of the 23 subjects enrolled, 4 dropped out before completing all phases and were excluded from the analysis. The mean age of the study patients (15 men, 4 women) was 68 years, and mean duration of disease was 9.6 years.

In the placebo group, the average daily fall frequency was 0.25, versus 0.13 in the donepezil group (P < .05).

Treatment with donepezil decreased the number of reported falls by about 50%. The near-falls rate was not significantly different and could reflect the subjectivity of how individual patients experienced a near-fall event. No significant difference was seen for ABC scale and UPDRS scores between phases.

Although this study did not determine the reason for reduced falls on donepezil, the results could be explained by either improved attention or cognitive functioning. The researchers concluded that the reduction in falls experienced by PD patients is important in avoiding injuries and thus enhances patients' quality of life and that larger trials of cholinergic augmentation are warranted.