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February 2003

Donepezil Use in the Treatment of Dementia Associated With Down Syndrome

Author Affiliations

Copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2003

Arch Neurol. 2003;60(2):292. doi:10.1001/archneur.60.2.292-a

In reply

Although Cipriani and colleagues indicate that we "completely omit" information about the adverse effects of donepezil, we would like to point out that this information is contained in the third paragraph of the "Comment" section of our article. No adverse effects attributable to study medications were observed as monitored using a standard adverse event checklist. Specifically, we saw no symptoms of cholinergic hyperstimulation (vomiting and abdominal pain) as reported by Hemingway-Eltomey and Lerner (cited in our reference 13). We disagree with Cipriani and colleagues that the clinical picture of dementia in DS has little similarity to AD in the general population. The DS Dementia Scale1 used in our study was adapted from symptoms of dementia in the general population with AD. We discussed the confounding developmental factors that arise when comparing AD in DS with AD in the general population in a recent review.2 In addition, we have reported that the pattern of dementia symptoms (measures of attention, memory, social communication, pathological reflexes, and atrophy on magnetic resonance imaging brain scans) in DS is consistent with the symptomatic expression of AD in the general population.3 We appreciate the authors' case descriptions of their patients and agree with them, as cited in the last sentence of our article, that based on the results of our pilot study, "further placebo-controlled trials of donepezil are indicated for the treatment of dementia in DS."