title: Safety and efficacy of rivastigmine in children with Down syndrome: A double blind placebo controlled trial.
abstract: Individuals with Down syndrome (DS) have decreased cholinergic function and an uneven profile of cognitive abilities, with more pronounced deficits in learning, memory, and expressive language. Cholinesterase inhibitors may improve cognitive function in adults and adolescents with DS, but studies in children with DS have been limited. This study aimed to: (i) investigate the safety and efficacy of rivastigmine treatment; (ii) build upon our open-label studies in children with DS in a double-blind, placebo-controlled clinical trial; and (iii) investigate specific cognitive domains that may respond to rivastigmine treatment. We conducted a 20-week double-blind, placebo-controlled trial to investigate the safety and efficacy of rivastigmine in 22 children and adolescents with DS aged 10-17 years. Safety measures included reports of adverse events, laboratory parameters, and electrocardiograms. Efficacy measures included parental assessments of adaptive behavior and executive function, and direct measures of language and memory. No group differences were found on safety measures and 22 of 24 participants that passed study screening completed the study. The results did not demonstrate evidence for significant improvement in aspects of cognition, language, or overall function in the children receiving rivastigmine. Our results suggest that rivastigmine is safe and well-tolerated for children and adolescents with DS, but may not be effective for improving performance on the selected measures in this study. However, larger samples and/or alternate measures could possibly reveal improvements in cognitive function with rivastigmine treatment. Further research is needed to define a battery of cognitive measures that is sensitive to treatment effects in DS. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
authors.forename: Gail A
authors.initials: GA
authors.lastname: Spiridigliozzi
authors.affiliation: Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Hart
authors.affiliation: Formerly of Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: James H
authors.initials: JH
authors.lastname: Heller
authors.affiliation: Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland.
authors.forename: Heather E
authors.initials: HE
authors.lastname: Schneider
authors.affiliation: Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
authors.forename: Jane Ann
authors.initials: JA
authors.lastname: Baker
authors.affiliation: Down Syndrome Clinic and Research Center, Kennedy Krieger Institute, Baltimore, Maryland.
authors.forename: Cathleen
authors.initials: C
authors.lastname: Weadon
authors.affiliation: Down Syndrome Clinic and Research Center, Kennedy Krieger Institute, Baltimore, Maryland.|Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: George T
authors.initials: GT
authors.lastname: Capone
authors.affiliation: Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
authors.forename: Priya S
authors.initials: PS
authors.lastname: Kishnani
mesh_terms: D000223:Adaptation, Psychological / Q000187:drug effects; D000293:Adolescent; D002648:Child; D003071:Cognition / Q000187:drug effects; D004314:Down Syndrome / Q000175:diagnosis / Q000188:drug therapy*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D000068836:Rivastigmine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000068836:Rivastigmine
keywords: Down syndrome; adaptive behavior; cholinesterase inhibitors; cognition; trisomy 21