Aricept Does Not Improve Chemo Brain, But Other Interventions Might

Aricept does not help improve cognitive impairment from chemotherapy, an expert told CURE®.

Although Aricept (donepezil), a cognition-enhancing drug commonly prescribed for Alzheimer’s disease, did not decrease the effects of chemotherapy-induced cognitive impairment in breast cancer survivors, one researcher said there is still hope, according to an expert.

“The key takeaway would be that [Aricept] probably won't make a difference in breast cancer survivors who have had chemotherapy one to five years following their treatment,” study author, Stephen R. Rapp, professor, Psychiatry and Behavioral Medicine, at Wake Forest University School of Medicine in Winston-Salem, North Carolina, said in an interview with CURE®.

However, more than half of women involved in a study of Aricept for chemotherapy-related cognitive impairment experienced an improvement in their cognition, regardless of which intervention they were given.

“The other [takeaway is that] we saw some women improve regardless of what treatment they're under. I think that gives great encouragement that cognitive impairment is malleable. It can be worked with.”

MORE: Expert Highlights Common Signs of Chemo Brain

Rapp and his team conducted a study on 276 breast cancer survivors who underwent four or more cycles of chemotherapy between one and five years before the start of the study. All participants reported cancer-related cognitive impairment. Participants were randomly assigned to receive Aricept (140 patients) or an inactive drug, known as a placebo (136 patients).

“The participants did not know which [drug] they were getting, and we, the researchers, did not know what they were getting either,” Rapp said.

The researchers then gathered patient data regarding cognitive functioning at the 12-, 24- and 36-week mark. At each of the time points, there was no difference in attention, executive functioning, verbal fluency, processing speed or self-reported cognitive functioning between the two groups.

Cognitive Functioning May Improve Over Time

However, the research team discovered an interesting finding at the 24-week mark.

“We also saw that two-thirds of women in both groups improved between baseline and 24 weeks,” Rapp explained. “Their scores on the cognitive tests we gave them — the memory tests in particular, but the other ones, too — improved.”

Improvements in cognitive functioning were seen both in patient-reported outcomes and in more objective tests, too. The researchers used the Hopkins Verbal Learning Test-Revised, which is a test that measures cognitive function via word recall.

“We have both the objective measure of actually how they did on these memory tests, but we also have their self-report what they perceived. In both cases, two-thirds of the women reported an improvement whether they were in the [Aricept] group or the placebo group.”

Rapp said that this is “an interesting finding which we can’t fully explain,” though he and other researchers are conducting a follow-up analysis to see if there are certain reasons or characteristics why cognitive functioning improved in some women and not others.

How to Improve or Preserve Cognitive Function

There are also some steps patients can take to improve or preserve cognitive function, according to Rapp, such as cognitive training or cognitive rehabilitation. According to the National Institutes of Health, cognitive rehabilitation is “a set of interventions that aim to improve a person’s ability to perform cognitive tasks by retraining previously learned skills and teaching compensatory strategies.”

Additionally, Rapp mentioned that there are techniques “from the dementia world” used to improve cognitive functioning that could be useful in cancer survivors.

“The recommendations are a good diet, eat right [and] sleep right,” Rapp said. “Keep active and exercise and then look for strategies that may reduce stress. So somethings that [are] popular now are meditational strategies that allow the individual to learn skills to basically turn down the nervous system a little bit, and that can make concentration and memory better. Those general strategies that have received a lot of support for a lot of health outcomes make a lot of sense for this population as well.”

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