Five cases of frontotemporal dementia with behavioral symptoms improved by Yokukansan

Donepezil is effective in maintaining cognitive function in patients with mild to moderate Alzheimer's disease (AD). However, not all patients respond to donepezil. In the present study, we examined the short- and long-term effects of donepezil on cognitive function after 2 years treatment. The present retrospective study was performed on 122 AD outpatients who had been taking donepezil for >= 1 year. All subjects underwent periodic examination of cognitive function (Mini-Mental State Examination (MMSE), Rorschach Cognitive Index (RCI)) and clinical evaluation on the Clinical Dementia Rating (CDR); first before starting treatment and then at 4-month intervals after initiation of donepezil. Patients were divided into three groups: (i) MG, the 'maintained' group, in which the global CDR score was maintained during treatment; (ii) DeG, the 'declined' group, in which the global CDR score increased; and (iii) DrG, the drop out group, who discontinued the treatment. Changes in scores on the MMSE and RCI were compared before treatment and at 4-month intervals within each group. In addition, over each 4-month period, MMSE and RCI scores were compared between the three groups. Furthermore, to investigate the condition of effective treatment, the reasons why donepezil treatment was discontinued in the DrG were examined. The most frequent reason for discontinuation was the appearance of behavioral and psychiatric symptoms of dementia (BPSD), which were more frequently observed in the DrG. Although depression and/or disinclination were more frequent in the MG, hyperactivity was more frequent in the DeG and DrG. Before treatment, patients in the DrG exhibited significantly lower scores on the MMSE than did patients in the MG and DeG. Upon examination 4 months after starting treatment, patients in the MG showed cognitive improvement on the MMSE and RCI, whereas those in the DeG showed cognitive deterioration on the MMSE. The results of the present study suggest that when a short-term beneficial effect of the donepezil on cognitive functions is seen, long-term effect may also be expected at 2 years. Periodic clinical evaluation and examination of cognitive function is indispensable for effective donepezil treatment.