Donepezil

Standard-of-care for Alzheimer's with robust evidence for modest symptomatic improvement. Does not halt disease progression.

A rough internal score reflecting quantity, quality, and consistency of human evidence. Not a clinical recommendation.

Multiple large RCTs demonstrate statistically significant improvements on ADAS-cog and global clinical impression scales in mild-to-severe AD. Effect size is modest (1.5–3 point improvement on ADAS-cog). Long-acting with once-daily dosing. Does not modify underlying disease progression.

• FDA-approved for mild, moderate, and severe Alzheimer's
• Once-daily dosing with long half-life
• Well-characterized safety profile from extensive post-marketing use

Start 5 mg/day, increase to 10 mg/day after 4–6 weeks. 23 mg/day formulation available for moderate-severe AD.

• Nausea
• Diarrhea
• Insomnia
• Muscle cramps
• Bradycardia

Cholinergic effects can worsen bradycardia, asthma, and peptic ulcers. GI side effects are dose-limiting. Gradual titration required.

Symptomatic treatment only — does not slow neurodegeneration. Clinical meaningfulness of observed effect sizes is debated.

• Memory55
• Focus40