Donepezil in the Prevention of Post-Operative Cognitive Decline

Study Overview
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Brief Summary
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The purpose of this study is to evaluate the feasibility of using Donepezil to prevent post-operative cognitive decline (POCD) among individuals aged 65 and older who have a baseline mild cognitive impairment (MCI) and are undergoing elective hip or knee replacement.

Detailed Description
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Up to 65% of elderly patients undergoing hip or knee surgery suffer from declining brain function known as post-operative cognitive decline (POCD). These individuals often stay in the hospital longer, have more complications, and are more likely to die. Recent clinical studies have shown the potential benefit of enhancing the cholinergic system among patients with both Alzheimer's disease and / or vascular dementia. Donepezil is currently being used to treat memory loss in patients with Alzheimer's disease. This study will recruit 30 cognitively impaired adults aged 65 or older who are scheduled to have elective hip or knee replacement surgery at University Hospital. Participants will be randomized to receive either a three to six week supply of Donepezil or a matching placebo approximately 4 weeks prior to surgery. This study will evaluate the effect of Donepezil on delirium incidence and severity during hospitalization, global cognitive function, length of hospitalization, site of discharge, and adverse drug effects. All material to be collected will be from interviews, questionnaires, and medical chart review. Some will be at baseline, during hospitalization, and 12 weeks post hospitalization and others will be daily during hospitalization. The International Study of Post-Operative Cognitive Decline battery of tests will be used in assessment, as will the CogHealth computerized battery.

Official Title
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Preventing Post-Operative Cognitive Decline

Conditions
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Delirium, Postoperative Complications

Intervention / Treatment
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* Drug: Donepezil


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Community-dwelling individuals aged 65 or older Scheduled for elective hip or knee replacement at University Hospital Mild cognitive impairment, defined as: MMSE total score of 27 or less; normal performance of the activities of daily living tasks of the Bristol scale after excluding mobility related difficulties; no chart-based dementia diagnosis; and no history of ever being on dementia medications such as Memantine or any cholinesterase inhibitors Consent to participate in the study Exclusion Criteria: Chart-based dementia diagnosis MMSE score greater than 27 Difficulty performing the activities of daily living not related to mobility as measured by the Bristol scale Current or past history of receiving dementia medications such as Memantine or any cholinesterase inhibitors (Tacrine, Donepezil, Rivastigmine, or Galantamine) Metastatic cancer or other comorbid illnesses likely to reduce life expectancy to under 6 months Multiple trauma or pathological fractures requiring acute hip or knee replacement Aphasic, blind, or deaf Use of neuroleptics one month prior to surgery Allergy to donepezil Inability to read and complete study tests and forms Alcohol or drug dependence, defined as intake of more than 5 units of alcohol daily during the past 3 months Not expected to be discharged from hospital or able to complete the 3-month postoperative test Not competent to make medical decisions

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Intervention/Treatment |
| --- |
|Drug: Donepezil|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in the International Study of Post-Operative Cognitive Decline (ISPOCD) and the CogHealth computerized battery tests at 1 week and 12 weeks after surgery |  |  | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Delirium status measured by the Confusion Assessment Method (CAM) and the Memorial Delirium Assessment Scale (MDAS) daily during the post-operative period |  |  | 
| Global cognitive status assessed using the Mini Mental Status Exam (MMSE) |  |  | 
| Length of stay in the hospital post-operatively |  |  | 
| Discharge site |  |  | 
| Adverse effects |  |  | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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dementia, MCI, Aricept, Adverse Effects, Hospital Acquired Complications, Cognitive Impairment, Aging