Rivastigmine in Parkinson's disease dementia.
Parkinson's disease has now evolved beyond what was considered to be a traditional motor disorder. It is being increasingly recognized that non-motor symptoms such as cognitive impairment, frank dementia, psychosis, depression, autonomic dysfunction and sleep disturbances are just as integral to the disease spectrum. The cholinergic system has been proposed to play a pivotal role in cognitive dysfunction. Based on interpretation of clinical studies in patients with Alzheimer's, cholinesterase inhibitors have also been studied for dementia associated with Parkinson's disease. Most of these include large and small placebo-controlled studies and several pilot studies have indicated that cholinesterase inhibitors have a favorable effect on cognition, psychiatric symptoms and global function in Parkinson's disease dementia. A large randomized placebo-controlled clinical trial showed that rivastigmine had moderate improvement in dementia associated with Parkinson's disease. The magnitude of effects in terms of scores for the cognitive subscale of the Alzheimer's disease assessment scale and Alzheimer's disease cooperative study-clinicians global impression of change were similar to those observed among patients with Alzheimer's disease who were treated with cholinesterase inhibitors. A transdermal patch which gradually releases rivastigmine over the application period is now available for use in mild to moderate dementia associated with Parkinson's disease and Alzheimer's disease.
Chitnis
Shilpa
S
UT Southwestern Medical Center-Neurology, 5323 Harry Hines Blvd, Dallas, Texas 75390-9036, USA. shilpa.chitnis@utsouthwestern.edu
Rao
Jayaraman
J
D000368:Aged; D001923:Brain Chemistry / Q000502:physiology; D003704:Dementia / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D017277:Drug Approval; D006801:Humans; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D010275:Parasympathetic Nervous System / Q000503:physiopathology; D010300:Parkinson Disease / Q000150:complications* / Q000523:psychology; D048448:Phenylcarbamates / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D000068836:Rivastigmine
D018696:Neuroprotective Agents; D048448:Phenylcarbamates; D000068836:Rivastigmine