Clinical effect of donepezil hydrochloride in the treatment of Parkinson's disease patients: a meta-analysis.

OBJECTIVE

To evaluate the therapeutic effectiveness of donepezil hydrochloride in patients with Parkinson's disease (PD) and inform subsequent management strategies.

METHODS

We systematically reviewed randomized and non-randomized studies on donepezil hydrochloride in PD patients, retrieved from PubMed, Web of Science, Embase, and the Cochrane Library, covering data from inception to March 2025. Meta-analysis was performed using RevMan 5.4 software.

RESULTS

Ten eligible studies were included. The meta-analysis revealed significant improvements in Mini-Mental State Examination (MMSE) scores in the treatment group compared to controls (SMD = 1.67, 95% CI [0.81, 2.54], P < 0.0001). The Unified Parkinson's Disease Rating Scale (UPDRS) scores were significantly reduced (SMD = -2.79, 95% CI: -4.85 to -0.74, P = 0.008), as were Clinician's Interview-Based Impression of Change (CIBIC+) scores (SMD = -0.27, 95% CI: -0.45 to -0.08, P = 0.004). Subgroup analysis indicated consistent improvements in MMSE scores across different subgroups, with significant differences observed. Heterogeneity was found in the age subgroup but not in the disease duration subgroup (< 3 years). Adverse events occurred in 42.07% (374/889) of the treatment group, with no heterogeneity across studies (I2 = 0%) and a statistically significant increase in risk (RR = 1.46, 95% CI [1.15, 1.84], P = 0.002).

CONCLUSION

The meta-analysis suggests that donepezil hydrochloride provides cognitive benefits for PD patients. However, the higher incidence of adverse reactions warrants careful consideration of the benefits and risks when using donepezil in clinical practice.