Donepezil, a medication commonly prescribed for Alzheimer’s disease and other types of dementia, does not typically make dementia worse at first, but some patients may experience an initial period of side effects that can mimic or feel like worsening symptoms. This can lead to confusion about whether the drug is harmful in the early stages of treatment.
Donepezil works by inhibiting an enzyme called acetylcholinesterase, which breaks down acetylcholine—a neurotransmitter important for memory and learning. By blocking this enzyme, donepezil increases acetylcholine levels in the brain, which can help improve communication between nerve cells and potentially slow cognitive decline. However, the benefits of donepezil are often modest and may take several weeks to become noticeable.
When patients start donepezil, some report side effects such as dizziness, nausea, diarrhea, loss of appetite, and sleep disturbances. These side effects can sometimes cause temporary confusion, fatigue, or other symptoms that might be mistaken for a worsening of dementia. For example, dizziness and gastrointestinal discomfort are common early side effects that can affect overall well-being and cognitive clarity. Some patients have also reported vivid dreams or nightmares shortly after starting the medication.
It is important to understand that these side effects usually improve after the first few days or weeks as the body adjusts to the medication. In many cases, patients who initially experience these symptoms find that their cognitive function stabilizes or even improves with continued use. However, because dementia itself is a progressive condition, some decline over time is expected regardless of medication.
The initial period after starting donepezil can be challenging for some patients and caregivers because the drug’s effects are not immediate and side effects can be uncomfortable. This can create the impression that the medication is making dementia worse, but this is generally a temporary phase. Doctors often start patients on a low dose (such as 5 mg daily) to minimize side effects and then gradually increase the dose if tolerated.
In rare cases, some individuals may not tolerate donepezil well and may experience persistent side effects or worsening symptoms, leading to discontinuation of the drug. Persistence with donepezil treatment varies widely, with many patients stopping within the first year due to side effects or perceived lack of benefit. Caregiver support and close monitoring by healthcare providers are crucial during this period to manage side effects and assess the drug’s effectiveness.
Overall, donepezil does not cause dementia to worsen at the start of treatment in a direct or permanent way. Instead, initial side effects can temporarily mimic worsening symptoms, but these usually subside. The medication aims to support cognitive function by enhancing acetylcholine levels, and while it does not cure dementia, it may slow symptom progression for some time. Patience and careful management during the early phase of treatment are key to maximizing the potential benefits of donepezil.
