Effects of rivastigmine on behavioral and psychological symptoms of dementia in Alzheimer's disease.
BACKGROUND
The presence of certain behavioral and psychological symptoms (eg, paranoia, hallucinations, aggression, activity disturbances) in Alzheimer's disease (AD) may predict faster cognitive and functional decline; therefore, such symptoms represent an important treatment target. Behavioral and psychological symptoms of dementia (BPSD) may be caused at least in part by cholinergic deficits. Regulatory studies of rivastigmine in AD were not designed to evaluate effects on BPSD, but further investigation of rivastigmine in AD was prompted by later studies demonstrating behavioral benefits in other types of dementia.


OBJECTIVE
The primary aim of this article was to review available data on the behavioral benefits of rivastigmine in patients with AD.


METHODS
Relevant data were identified through a MEDLINE search for studies published in peer-reviewed journals through January 2004. The search terms were Alzheimer, behavior, psychosis, and rivastigmine. Data presented at international scientific congresses were also reviewed to ensure that the most recent data were considered.


RESULTS
A meta-analysis of three 6-month, placebo-controlled trials of rivastigmine in mild to moderate AD indicated that rivastigmine 6 to 12 mg/d may improve or prevent disruptive BPSD (P < 0.05 vs placebo). In patients with more advanced AD, 2 open-label studies of up to 12 months' duration found that improvements in BPSD were accompanied by a decrease in the use of psychotropic medications. Rivastigmine demonstrated behavioral benefits in patients with dementia with Lewy bodies (DLB) in a double-blind, placebo-controlled study (P < 0.05). In open-label extension studies, rivastigmine provided sustained effects (up to 2 years) in patients with mild to moderate AD or DLB.


CONCLUSIONS
The available dats suggest that rivastigmine may be a well-tolerated treatment option for improving or preventing psychotic and nonpsychotic symptoms associated with AD. Prospective, double-blind studies are needed to evaluate these preliminary findings.
Finkel
Sanford I
SI
Department of Psychiatry, University of Chicago Medical School, Chicago, Illinois, USA. sandy.finkel@cje.net
D000544:Alzheimer Disease / Q000145:classification / Q000188:drug therapy* / Q000523:psychology; D002219:Carbamates / Q000627:therapeutic use*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy* / Q000209:etiology; D015201:Meta-Analysis as Topic; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D048448:Phenylcarbamates; D000068836:Rivastigmine; D012720:Severity of Illness Index; D016896:Treatment Outcome
D002219:Carbamates; D002800:Cholinesterase Inhibitors; D018696:Neuroprotective Agents; D048448:Phenylcarbamates; D000068836:Rivastigmine