Reasons for mental state decline after taking donepezil (Aricept) for 20 days

Donepezil (Donepezil) is a commonly used acetylcholinesterase inhibitor, mainly used to improve cognitive function in patients with mild to moderate Alzheimer's disease. Its mechanism of action is to inhibit the breakdown of acetylcholine and increase the level of acetylcholine in the synaptic cleft of the brain, thereby improving memory and cognitive functions. However, during clinical use, some patients experienced a decline in mental status after taking it for about 20 days, which requires attention.

Decreased mental status may be related to adverse drug reactions. Although donepezil is generally well tolerated, it may still cause neuropsychiatric symptoms such as insomnia, anxiety, depression, or mood swings. In some patients, during the initial phase or dose adjustment, a sharp increase in brain choline levels may trigger mild cognitive or mood swings, manifesting as a decline in mental status.

Interactions between medications and the patient's pre-existing conditions or concomitant medications may also result in abnormal mental status. Donepezil works through the central nervous system. If the patient takes other drugs that affect the central nervous system (such as sedative-hypnotics, antidepressants or antipsychotics) at the same time, cumulative effects or drug interactions may occur, causing the patient to experience symptoms such as drowsiness, confusion, and decreased concentration. In addition, patients' existing underlying neurological diseases or metabolic abnormalities (such as impaired liver and kidney function) may also aggravate adverse drug reactions.

Decline in mental status may also be related to individual patient differences and disease progression. The cognitive function of patients with Alzheimer's disease may fluctuate with the course of the disease. Coupled with individual differences in the regulation of choline levels by medications, some patients may experience a temporary decline in mental status in the short term. Clinically, the patient's cognitive, emotional and behavioral changes should be closely monitored, the dosage should be adjusted or medication suspended when necessary, and psychological support and life intervention should be combined to ensure the safety and effectiveness of the treatment.

Reference link:https://www.drugs.com