Brain perfusion effects of cholinesterase inhibitors in Parkinson's disease with dementia.
Several evidences suggest that cholinergic deficits may significantly contribute to dementia in Parkinson's disease (PDD) and acetylcholinesterase inhibitors (ChEIs) have been reported to improve cognitive symptoms in PDD, without worsening parkinsonism. Nineteen PDD patients underwent brain perfusion SPECT with (99m)Tc-ethyl cysteinate dimer after 6 months ChEIs treatment in order to evaluate the functional correlates of clinical improvement. A clear-cut cognitive improvement was reported in PDD patients with a significant improvement of ADAS-cog total score as well as of subscores exploring executive functions (p<0.01). MMSE total score did not significantly change after ChEIs but the subscore of attention significantly improved after therapy (p<0.01). No difference in motor performance as evaluated by UPDRS was reported. SPM analysis showed a significant increase of perfusion (p < 0.0001) in bilateral cingulate, and frontal regions after ChEIs. Our data confirm the efficacy of ChEIs in the treatment of dementia associated with PD mainly on attention and executive functions, and the functional findings indicate that this cognitive improvement could be associated with a sort of pharmacological frontal "re-afferentation".
Ceravolo
R
R
Department of Neuroscience, Neurology Section, University of Pisa, Pisa, Italy. r.ceravolo@neuro.med.unipi.it
Volterrani
D
D
Frosini
D
D
Bernardini
S
S
Rossi
C
C
Logi
C
C
Manca
G
G
Kiferle
L
L
Mariani
G
G
Murri
L
L
Bonuccelli
U
U
D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D001921:Brain / Q000187:drug effects* / Q000378:metabolism; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003704:Dementia / Q000188:drug therapy* / Q000209:etiology; D000077265:Donepezil; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007189:Indans / Q000627:therapeutic use; D008297:Male; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy*; D048448:Phenylcarbamates / Q000627:therapeutic use; D010880:Piperidines / Q000627:therapeutic use; D000068836:Rivastigmine; D015899:Tomography, Emission-Computed, Single-Photon
D000978:Antiparkinson Agents; D002800:Cholinesterase Inhibitors; D007189:Indans; D048448:Phenylcarbamates; D010880:Piperidines; D000077265:Donepezil; D000068836:Rivastigmine