An oral combination that includes Aricept (donepezil) — an Alzheimer’s therapy — and Ginkgo biloba improved cognitive abilities and quality of life in people with Parkinson’s disease dementia (PDD) treated for six months, a study from China reports.
The study, “The efficacy of a ‘cocktail therapy’ on Parkinson’s disease with dementia,” appeared in the journal Neuropsychiatric Disease and Treatment.
Scientists at The Second Hospital of Baoding City investigated the efficacy and safety of combining Aricept tablets, butylphthalide and oxiracetam capsules, and Ginkgo biloba extract tablets to treat PDD.
Use of butylphthalide — a component of celery oil — has been associated with better thinking skills in people with vascular cognitive impairment but not dementia. Butylphthalide is thought to benefit the brain’s energy metabolism and blood circulation, and has been shown to ease learning and memory problems in a rat model of stroke.
Better cognitive function and brain metabolism are also associated with oxiracetam, while Ginkgo biloba extract has shown benefits in a rat model of dementia and improved thinking abilities in Parkinson’s patients with mild cognitive impairment.
Aricept (by Eisai and Pfizer) is an approved oral treatment for mild to moderate Alzheimer’s in the U.S., and recommended in China for PDD patients. It works by slowing the breakdown of acetylcholine at the synapse — the sites where nerve cells communicate — by blocking the acetylcholinesterase enzyme.
In this six-month study in 60 patients (32 men, mean age 68.6), 30 received a “cocktail” therapy consisting of 10 mg of Aricept (after a 5 mg dose over four weeks) once daily, and of 200 mg of dl-3n-butylphthalide, 800 mg of oxiracetam, and 80 mg of Ginkgo biloba extract given three times each day. The other 30 PDD patients served as controls, and received Aricept once daily.
All were treated between January 2011 and October 2016, and were using levodopa. To be diagnosed with Parkinson’s dementia, the patients’ cognitive problems had to impact their daily living abilities, and this diminishment had to be observed for at least one year after the onset of dyskinesia (the disease’s involuntary, jerky movements).
Patients’ cognitive function was assessed using the Montreal cognitive assessment scale (MoCA), the Blessed-Roth dementia scale, and the Clinical Dementia Rating Scale sum of boxes before treatment, and again at three and six months of treatment.
Results showed that people on the cocktail therapy had better scores across the three tests at six months in comparison to assessments made at the study’s start and at three months. No statistically significant differences were found among those in the control group.
Specifically, analysis of the different MoCA test components showed more significant benefits in visual-spatial ability and executive function, naming, attention, memory, and orientation with the combination treatment than with Aricept alone. Language skills and abstract thinking also improved in the combination treatment group relative to controls, but to a lesser degree, the study said.
The cocktail was also seen to have “good safety,” with rates of abnormal liver function similar between the two — 16.67% in the “cocktail” therapy and 13.33% in the controls. No adverse events related to the digestive system, nervous system, or allergies were noted over the course of treatment.
“Treatment with ‘cocktail therapy’ was safe and improved the conditions of patients with PDD, as well as the quality of life,” the scientists wrote. However, they cautioned that studies with larger groups of patients and longer treatment times are needed to verify the results.