title: Effects of cholinesterase inhibitors in Parkinson's disease dementia: a review of clinical data.
abstract: OBJECTIVE
  Cognitive impairment and dementia are common features of Parkinson's disease (PD). Patients with Parkinson's disease dementia (PDD) often have significant cholinergic defects, which may be treated with cholinesterase inhibitors (ChEIs). The objective of this review was to consider available efficacy, tolerability, and safety data from studies of ChEIs in PDD.
  
  
  CONCLUSIONS
  A literature search resulted in the identification of 20 relevant publications. Of these, the treatment of PD patients with rivastigmine, donepezil, or galantamine was the focus of six, eleven, and two studies respectively, while one study reported use of both tacrine and donepezil. The majority of studies were small (<40 patients), with the exception of two large randomized controlled trials (RCTs) that are the main focus of this review. In the smaller studies, treatment benefits were reported on a range of outcome measures, though results were extremely variable. While the full results of a large RCT of donepezil in patients with PDD are not yet available, significant treatment differences were reported on the CIBIC-plus at the highest treatment dose. A trend toward improvement was also observed in treated patients on the ADAS-cog. The second large RCT found significant improvements in rivastigmine-treated patients compared with placebo on both the ADAS-cog (P < 0.001) and the ADCS-CGIC (P < 0.007), as well as on all secondary efficacy outcomes. Consequently, rivastigmine is now widely approved for the symptomatic treatment of mild to moderate PDD.
  
  
  CONCLUSIONS
  Taken together, these studies suggest that ChEIs are efficacious in the treatment of PDD.
authors.affiliation: Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. t.van.laar@neuro.umcg.n
authors.forename: Teus
authors.initials: T
authors.lastname: van Laar
authors.forename: Peter Paul
authors.initials: PP
authors.lastname: De Deyn
authors.forename: Dag
authors.initials: D
authors.lastname: Aarsland
authors.forename: Paolo
authors.initials: P
authors.lastname: Barone
authors.forename: James E
authors.initials: JE
authors.lastname: Galvin
mesh_terms: D000818:Animals; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003704:Dementia / Q000188:drug therapy* / Q000201:enzymology / Q000523:psychology*; D006801:Humans; D010300:Parkinson Disease / Q000188:drug therapy* / Q000201:enzymology / Q000523:psychology*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors