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Delayed Blink Reflex in Dementia With Lewy Bodies Is Sensitive to Cholinergic Modulation

Anzellotti, Francesca MD; Bonanni, Laura MD, PhD; Iorio, Eva PhD; Di Baldassarre, Fabiana MD; D'Andreagiovanni, Anna MD; Monaco, Daniela MD; Thomas, Astrid MD, PhD; Onofrj, Marco MD

doi: 10.1097/WNF.0b013e31815e5d7f
Original Articles

Objectives: To assess the possible responsiveness of blink reflex alterations present in dementia with Lewy bodies (DLB) to treatment with cholinesterase inhibitors.

Methods: Twenty-six patients with DLB and 20 patients with Alzheimer disease underwent clinical, neuropsychological (including assessment of cognitive fluctuations, with the Cognitive Assessment of Fluctuations and the One-Day Fluctuation Assessment questionnaires), and the blink reflex evaluation at baseline, 1 week after vitamin E administration (to assess test-retest reliability), and 1 and 2 weeks after donepezil administration at the dose of 10 mg/d. Results were compared with data obtained from 30 healthy controls treated with vitamin E capsules for 2 weeks.

Results: Treatment with donepezil did not cause modifications of cognitive or motor performances in both groups of patients. In DLB patients, One-Day Fluctuation Assessment scores were modified by donepezil treatment with a mean reduction of 2.8 ± 1.8 compared with baseline (P < 0.05). After 2 weeks of treatment with donepezil, R2 latency was significantly decreased in DLB patients. The mean R2 latency reduction was by 3.0 ± 3.2 milliseconds (P < 0.0001 compared with baseline). R2 mean latency reduction was significantly correlated with R2 mean latency delay at baseline (Spearman rho = 0.8).

Conclusions: Short-term donepezil administration can correct the alterations of the blink response together with the daily occurrence of cognitive fluctuations present in DLB patients.

Neurophysiopathology Unit, Department of Oncology and Neuroscience, University "G. D'Annunzio," "G. D'Annunzio" Foundation CE.S.I, Chieti-Pescara, Italy.

Disclosure: None of the authors received financial support for the study. All the authors except L.B, E.I, and F.D.B., received payments from EISAI for randomization and the study of donepezil in 2 international protocols, where 8 patients with Parkinson Disease with dementia and 23 patients with Alzheimer disease had been enrolled.

Address correspondence and reprint requests to Marco Onofrj, MD, Neurophysiopathology, University G.D'Annunzio of Chieti-Pescara, Via Fonte Romana, 65124 Pescara, Italy; E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.