A systematic review of the effectiveness of rivastigmine for the treatment of behavioral disturbances in dementia and other neurological disorders.
BACKGROUND
Dementia is frequently associated with behavioral disturbances, some of which have a significant impact on patient quality of life and the likelihood of institutionalization. Cholinergic systems, among other neurotransmitters in the brain, appear to be involved with different behaviors, such as psychosis, depression, agitation, and personality changes.


METHODS
This paper reviews the clinical data on the effectiveness of rivastigmine, a dual inhibitor of acetylcholinesterase and butyrylcholinesterase, in ameliorating behavioral disturbances in different patient populations. Relevant articles were identified through MEDLINE searches with no date restrictions.


RESULTS
In particular, rivastigmine has shown efficacy in treating behavioral disturbances in patients with a wide range of dementias - Alzheimer's disease, vascular dementia, fronto-temporal dementia, mixed dementia, Lewy body dementia, Parkinson's disease with dementia, and schizophrenia with dementia. Most of the studies have been open-label clinical trials with behavior as a secondary endpoint. The behavior domains that most consistently showed improvement were apathy/indifference, anxiety, delusions (psychosis), and hallucinations. The major limitation of this review is that the effects on behavioral symptoms were usually secondary endpoints in clinical trials.


CONCLUSIONS
The efficacious effects of treatment with rivastigmine on various behavioral disturbances provide supporting evidence that cholinergic mechanisms, among other neurotransmitters, are involved in the manifestation of some behavioral and psychological symptoms of dementia.
Southeastern Geriatric Healthcare Group, Snellville, GA 30078, USA. GLFigiel@aol.com
Gary
G
Figiel
Carl
C
Sadowsky
D000109:Acetylcholine / Q000502:physiology; D002799:Cholinergic Fibers / Q000502:physiology; D003704:Dementia / Q000188:drug therapy*; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy*; D009422:Nervous System Diseases / Q000188:drug therapy*; D018696:Neuroprotective Agents / Q000627:therapeutic use; D048448:Phenylcarbamates / Q000627:therapeutic use*; D000068836:Rivastigmine; D016896:Treatment Outcome
D018696:Neuroprotective Agents; D048448:Phenylcarbamates; D000109:Acetylcholine; D000068836:Rivastigmine