Cognitive, psychiatric and motor response to galantamine in Parkinson's disease with dementia.
BACKGROUND
Cholinesterase inhibitors with additional nicotinic activity, such as galantamine, may be useful in PD patients with dementia (PDD) since stimulation of nicotinic receptors may prevent the down-regulation that is likely to accompany cholinesterase inhibition and facilitate dopamine release in the striatum.


METHODS
Sixteen PDD patients (six female) with onset of cognitive impairment after at least one year with parkinsonism participated in this open-label trial of galantamine. Cognitive, psychiatric, and motor symptoms were assessed before and after 8 weeks of treatment with galantamine using unstructured clinical assessment as well as rating scales including the Mini-Mental State Examination (MMSE), clock drawing test, verbal fluency and selected items from the Neuropsychiatric Inventory (NPI).


RESULTS
Age (mean, SD) was 75.6 (5.2) years, duration of PD 13.4 (5.9), duration of dementia 2.1 (1.7) years, Hoehn and Yahr score was 3.8 (0.8) and baseline MMSE score was 17.7 (6.7). Side-effects caused discontinuation in three patients, but were rare and mild in the remaining 13. Improvement of global mental symptoms was noted in eight patients, whereas worsening was reported in four. Hallucinations improved in seven of the nine patients with hallucinations before treatment. Parkinsonism improved in six patients, but a mild worsening of tremor was noted in three. Clock-drawing improved (p=0.016), and trends towards improvement on MMSE (p=0.09) and verbal fluency (p=0.16) were found.


CONCLUSIONS
Although controlled trials are needed, the findings suggest that galantamine is useful in patients with PDD.
Aarsland
D
D
Section of Geriatric Psychiatry, Rogaland Central Hospital, Stavanger, Norway. daa@sir.no
Hutchinson
M
M
Larsen
J P
JP
D000368:Aged; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000188:drug therapy / Q000523:psychology; D003704:Dementia / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D005702:Galantamine / Q000627:therapeutic use*; D006212:Hallucinations / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D018697:Nootropic Agents / Q000627:therapeutic use*; D010300:Parkinson Disease / Q000188:drug therapy* / Q000523:psychology; D016896:Treatment Outcome
D002800:Cholinesterase Inhibitors; D018697:Nootropic Agents; D005702:Galantamine