testosterone blend 400’s disease (AD) is the most common form of dementia in the elderly population. [2-4] According to date data, 35.6 million. People worldwide suffer from dementia.Its incidence is increasing rapidly, the testosterone blend 400’s Association predicts that by 2050, every 85 persons in the world will suffer from dementia in testosterone blend 400’s disease. 
Dementia is a costly disease in terms of social, economic and health costs. Almost 60% of the burden of dementia is on low- and middle-income countries, and in subsequent years, this burden may increase. According to WHO estimates, in Russia there are about 1.2 million. Dementia patients.
Estimated annual global costs of dementia society -.. 604 billion US dollars, demonstrate how dementia has a huge impact on the socio-economic situation in the world. At the same time, in countries with high income share of the cost of informal care (45%) and direct costs of social care (40%) of the total cost is about the same, while the share of direct medical costs (15%). 
dementia therapy optimization with increased availability of effective treatment can allow not only to improve the quality of life of patients, but also lead to savings at the expense of slowing the progression of the disease and related direct medical (hospitalization) and non-medical costs, as well as intangible costs associated with the load on relatives patient.
- drugs acting on acetylcholinergic system – first line therapy
- drugs acting on NMDA-receptors (shown only in the moderate to severe dementia severity)
Rationale for the use of the drug Alzepil
ALZEPIL ® (donepezil) inhibits the activity of acetylcholinesterase (AChE), enhancing cholinergic neurotransmission in the cerebral cortex. It slows down the progression of testosterone blend 400’s disease, reduces the severity of cognitive symptoms, in some cases, restore the daily activity of patients and facilitates care of them. Corrects behavioral abnormalities, reduce apathy, hallucinations and repetitive movements unthought.  preferably donepezil inhibits acetylcholinesterase and not butyrylcholinesterase – an enzyme which is largely outside the central nervous system (that explains it better than other acetylcholinesterase inhibitors, portability) [1,8]
Donepezil is included in various international and Russian leadership as the drug of first-line treatment of dementia in testosterone blend 400’s disease:
- Donepezil, galantamine, rivastigmine and memantine for the treatment of disease of testosterone blend 400’s. The NICE technology appraisal 217 Guidance ;
- The APA : Practice Guideline The for the Treatment of Patients with of testosterone blend 400’s Disease and Dementias OTHER 
- Donepezil is part of a specialized standard of care for testosterone blend 400’s disease
Clinical data :
- 1. The efficacy and safety of donepezil, rivastigmine and galantamine in the treatment of testosterone blend 400’s disease: a systematic review and meta-analysis 
Level of Evidence: IA
Authors: Richard A Hansen, Gerald Gartlehner
Source: Cochrane Database, 2008
Objective: To evaluate the clinical efficacy and tolerability of use of drugs of acetylcholinesterase inhibitors (iAHE) for the treatment of dementia in testosterone blend 400’s disease
Materials and Methods: A systematic review and meta-analysis of the data included 33 publications, 26 randomized, double-blind study, which assessed the efficacy and tolerability of iAHE (donepezil, rivastigmine and galantamine) in the treatment of testosterone blend 400’s dementia.
Differences in efficacy were assessed on a number of scales applied in the studies included in the analysis (MMSE, CIBIC +, ADCS-ADL, DAD, GDS, NPI and ADAS-cog).
As a result of the meta-analysis found no statistically significant difference in the effectiveness of drugs compared on any of the used rating scales. In this case, the lowest overall incidence of adverse events was noted when using donepezil and rivastigmine highest at application (Table 1)
Table 1. Results of a meta-analysis of various iAHE portability, the average frequency of adverse events (AEs)
- 2. The efficacy and safety of donepezil in the treatment of testosterone blend 400’s disease: results of a multicenter double-blind randomized study. [eleven]
Evidence level IIA
Authors: Rogers SL, Doody RS, Mohs RC, Friedhoff LT.
testosterone blend 400’s disease is mild to moderate
Ambulatory patients with testosterone blend 400’s disease of mild to moderate from 23 centers in the USA were randomized into groups receiving placebo, 5 mg of donepezil hydrochloride or 10 mg of Donepezil hydrochloride (5 mg / day for the first week and then 10 mg / day) once a hours before bedtime. A total of 468 patients participated in the test, 97% of which were included in the analysis on the principle of “intention to treat”. Donepezil resulted in a statistically significant performance improvement scales ADAS-cog, CIBIC-plus, and MMSE (Minianaliz mental state) compared with placebo. Average ultimate differences between drug and placebo groups received 5 mg / day and 10 mg / day of donepezil hydrochloride were, respectively, 2.5 and 3.1 on a scale ADAS-cog (p <0,001); 0.3 and 0.4 points on a scale of CIBIC plus (p <0,008); and 1.0 and 1.3 points on a scale MMSE (p <0,004). According scale CIBIC plus, 32% and 38% of patients receiving, respectively, 5 mg / day and 10 mg / day Donepezil hydrochloride showed improvement of clinical signs (score of 1, 2 or 3) compared to placebo (18%). The incidence of adverse events requiring treatment in both dosage groups, donepezil (68-78%) was comparable to the level observed in the placebo group (69%). The dose of 10 mg / day Donepezil hydrochloride was associated with transient and mild symptoms of nausea and diarrhea, insomnia. No therapeutic intervention requiring clinically significant abnormalities in vital signs or the results of clinical laboratory tests were observed. Moreover, donepezil has not been associated with the hepatotoxic effects observed in case of the cholinesterase inhibitor class of acridine.
- 3. Efficacy and safety of prolonged use of donepezil in the treatment of testosterone blend 400’s disease: results of a multicenter open-label study. 
Evidence level IIA
Authors: Rogers SL, Doody RS, Pratt RD, Leni JR.
As part of a multicenter open trial evaluated the long-term efficacy and safety of donepezil in patients with testosterone blend 400’s disease and mild to moderate severity. 133 patients selected for the study, before it underwent a 14-week, randomized, double-blind, placebo-controlled trial with donepezil. In an open trial, patients initially treated with a daily dose of 3 mg of donepezil, which is then gradually increased to 5, 7 and 10 mg / day. Assessment of the patients was performed at every clinic visit 3 weeks to 12 weeks and then every 12 weeks for up to 240 weeks (total of 254 weeks). Efficacy was assessed by evaluating testosterone blend 400 scale-cognitive subscale (ADAS-cog) and clinical dementia symptom assessment scale – the amount of scale boxes (CDR-SB), after which the data was compared with the prognostic criteria to previously untreated patients with AD. In the first 6-9 months of testing observed clinical improvement in average scores ADAS-cog and CDR-SB, compared with baseline, then these figures are gradually deteriorating. In general, such deterioration was evaluated less, if this group of patients have not previously received therapy. The most common side effects were related to the nervous and digestive systems, as a rule, were lightweight and temporary in nature and did not require dose adjustment. there was no evidence of hepatotoxicity observed. Thus, these data indicate that donepezil is well-tolerated, effective therapy symptomatic asthma duration of up to 4.9 years.
- 4. donepezil for the treatment of vascular cognitive impairment. 
Level of Evidence: IA
Authors: Malouf R, Birks J.
Source: Cochrane Database, 2004
Objective: To evaluate the clinical efficacy, tolerability of donepezil in disorders of cognitive function, to evaluate the day’s activities and the social function of people with vascular cognitive impairment
Materials and Methods: A systematic review combined all relevant randomized trials are in the Special Register of the Cochrane in the “Dementia and cognitive impairment.” In this study included only randomized, double-blind study, where donepezil was compared with placebo.
The degree of cognitive impairment were determined by the MMSE and ADAS-cog at 12 and 24 weeks of treatment with donepezil \ placebo
The general condition of the patient was assessed on a scale SIBIC-plus
Results of the study in 1218 patients with cognitive impairment from mild to moderate severity, or in patients with probable or suspected vascular dementia showed donepezil improves cognitive function, overall patient and day patient activity.
Donepezil effective for any type of dementia position rapid improvement of cognitive functions
- 5. Current treatment for testosterone blend 400’s disease: Do they have satisfied those who care for such patients? 
The level of evidence IB
Author: Sevilla et.al.
Objective: To determine the degree of satisfaction of caregivers of patients with testosterone blend 400’s disease (AD), monotherapy with his players using donepezil, galantamine, rivastigmine and memantine.
Materials and Methods: A multicenter open-label study. Those who care for patients with asthma, filled questionnaire SATMED-Q * (Treatment Satisfaction with MEDicines Questionnaire – Questionnaire satisfaction drug), designed to assess pharmacotherapy in terms of (1) Portability (2) efficiency, (3) information exchange with doctor, (4) the ease and convenience of use (5) impact on daily activities, and (6) of overall satisfaction. The survey was carried out only once during the period between September and December 2007
Patients. 829 patients (63.3% women) with probable asthma of any severity (MMSE 17,8 ± 5,4 points) at the age of 78,2 ± 6,8 years.
Treatment. 546 (67.3%) patients received donepezil, 106 (13.1%) – rivastigmine, 99 (12.2%) – galantamine and 60 (7.4%) – memantine.
Results: According to the results of the survey, satisfaction with donepezil was more than all the other drugs for asthma treatment satisfaction in general 71,8 ± 12,3 points (p <0,05) and overall satisfaction with treatment donepezil 81.6 ± 18 4 points (p <0,01). Also donepezil was superior to rivastigmine and galantamine for the ease and convenience of use of 81,5 ± 17,4 points (p <0,01) and tolerability of 96,0 ± 12,9 points (p <0,05). Among the respondents, the number of people who are satisfied with donepezil was 76.7%, compared with 68.7, 61.4 and 46.7% among those who are satisfied with galantamine, rivastigmine and memantine, respectively (p = 0,0002).
Receiving Donepezil it can be combined with great convenience, compliance and satisfaction with family, than the use of non-selective iAHE and memantine. kob anavar