Efficacy of rivastigmine on executive function in patients with Parkinson's disease dementia.
OBJECTIVE
Rivastigmine is approved in the USA for the treatment of mild to moderate Alzheimer's disease and Parkinson's disease dementia (PDD). Executive function (EF) deficits are a core symptom of PDD. The current objective was to investigate the effects of rivastigmine capsules versus placebo on EF in PDD, focusing on secondary outcome measures from a large, international, randomized, double-blind, placebo-controlled, 24-week trial (EXPRESS, CENA713B2311).


METHODS
Secondary outcomes included Delis-Kaplan Executive Function System (D-KEFS) measures of EF. Data from three D-KEFS subtests (Card Sorting, Letter Fluency, Color-Word Interference), plus the Symbol Digit Modalities Test were analyzed in the observed case (OC) population. Changes from baseline in the rivastigmine versus placebo groups were evaluated using the van Elteren test blocking for country.


RESULTS
Of 541 patients in the EXPRESS study, 402, 71, 97, and 65 patients provided data for Letter Fluency, Card Sorting and Color-Word Interference subtests, and the Symbol Digit Modalities Test, respectively. On Letter Fluency, rivastigmine was associated with improvements in correct responses, set loss errors, and responses made (all P < 0.05), but not repetition errors. Higher Card Sorting recognition description score (P= 0.03), and more correct substitutions on the Symbol Digit Modalities Test (P= 0.02) were also recorded.


CONCLUSIONS
Rivastigmine was associated with significant improvements over placebo on EF tests evaluating flexibility of thinking, problem solving and planning in patients with PDD. These findings support the hypothesis that rivastigmine may affect frontal subcortical circuits, which potentially contributes to observed clinical improvement associated with EF.
University of Kentucky, Sanders-Brown Center on Aging, Lexington, KY 40536-0230, USA. fascom@email.uky.edu
Frederick A
FA
Schmitt
Martin R
MR
Farlow
Xiangyi
X
Meng
Sibel
S
Tekin
Jason T
JT
Olin
D000368:Aged; D003704:Dementia / Q000188:drug therapy* / Q000209:etiology* / Q000523:psychology; D004311:Double-Blind Method; D056344:Executive Function / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications*; D048448:Phenylcarbamates / Q000627:therapeutic use*; D011340:Problem Solving / Q000187:drug effects; D011932:Reading; D000068836:Rivastigmine; D013850:Thinking; D016896:Treatment Outcome
D018696:Neuroprotective Agents; D048448:Phenylcarbamates; D000068836:Rivastigmine