Effects of rivastigmine in patients with and without visual hallucinations in dementia associated with Parkinson's disease

  title={Effects of rivastigmine in patients with and without visual hallucinations in dementia associated with Parkinson's disease},
  author={David J. Burn and Murat Emre and Ian G. McKeith and Peter Paul de Deyn and Dag Aarsland and Chuanchieh Hsu and Roger M. Lane},
  journal={Movement Disorders},
We aimed to determine prospectively whether rivastigmine, an inhibitor of acetylcholinesterase and butyrylcholinesterase, provided benefits in patients with and without visual hallucinations in a population with dementia associated with Parkinson's disease (PDD). This was a 24‐week double‐blind placebo‐controlled study. Primary efficacy measures were the Alzheimer's Disease Assessment Scale cognitive subscale (ADAS‐cog) and Alzheimer's Disease Cooperative Study–Clinician's Global Impression of… 

Effects of rivastigmine in Alzheimer's disease patients with and without hallucinations.

Hallucinations predicted greater treatment responses to oral rivastigmine, and interaction testing suggested that differences in treatment effects were significant between hallucinators and non-hallucinators.

Evaluating Rivastigmine in Mild-to-Moderate Parkinson’s Disease Dementia Using ADAS-Cog Items

Overall, rivastigmine was associated with improvements on individual cognitive items and general cognitive domains and showed significant effects versus placebo on all domains: memory, language, and praxis.

Rivastigmine in dementia associated with Parkinson's disease and Alzheimer's disease: similarities and differences.

The magnitude of effect with rivastigmine versus placebo is quantitatively comparable in patients with AD and PD, but the treatment effect tended to be one of stabilization in AD, while in PDD improvements over baseline were seen.

Effects of Rivastigmine on Tremor and Other Motor Symptoms in Patients with Parkinson’s Disease Dementia

Rivastigmine did not induce clinically significant exacerbation of motor dysfunction in patients with PDD and posthoc analysis showed that similar improvements in the symptoms of dementia, including the ability to perform activities of daily living, were seen regardless of whether exacerbations of tremor was reported during the study.

Rivastigmine versus placebo in hyperhomocysteinemic Parkinson's disease dementia patients

Elevated homocysteine was associated with greater rivastigmine treatment differences than normal/low homocy steine, and was associatedwith greater rvastigmin treatment differences more than normal /low homocrysteine.

Rivastigmine for mild cognitive impairment in Parkinson disease: A placebo‐controlled study

Rivastigmine in PD‐MCI showed a trend effect for improvements on a global rating of cognition, disease‐related health status, and anxiety severity, and significant improvement on a performance‐based measure of cognitive abilities.

Rivastigmine in Parkinson’s disease dementia

There is evidence that PDD is associated with a cholinergic deficit, supporting the therapeutic role of cholinesterase inhibitors, which are already first-line agents in the treatment of Alzheimer’s disease.

Management of visual hallucinations in dementia and Parkinson’s disease

Atypical antipsychotics were frequently studied, but with the exception of clozapine in Parkinson’s disease dementia, results were equivocal and there was some evidence that acetylcholinesterase inhibitors may help visual hallucinations.

Rivastigmine for the Treatment of Parkinson’s Disease Dementia

Rivastigmine is a safe and effective symptomatic treatment for PDD conferring benefits with respect to cognition, function and overall clinical outcome and the comparable efficacy to other cholinesterase inhibitors is established.

Rivastigmine in Parkinson's disease dementia

  • S. ChitnisJ. Rao
  • Psychology, Medicine
    Expert opinion on drug metabolism & toxicology
  • 2009
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.



Rivastigmine for dementia associated with Parkinson's disease.

Rivastigmine was associated with moderate improvements in dementia associated with Parkinson's disease but also with higher rates of nausea, vomiting, and tremor; however, the differences between these two groups were moderate and similar to those reported in trials of rivastIGmine for Alzheimer's disease.

Hallucinations in Parkinson's disease: prevalence, phenomenology and risk factors.

Findings indicate that, when minor hallucinations are included, the total prevalence of hallucinations in Parkinson's disease is much higher than previously reported, and a simple side-effect of dopaminergic treatment is not sufficient to explain the occurrence of all visual hallucinations.

Neuroleptic sensitivity in Parkinson's disease and parkinsonian dementias.

An operationalized evaluation of severe NSR blind to diagnosis confirmed the high prevalence in DLB and identified high frequencies in Parkinson's disease and PDD with important implications for clinical practice.

A Detailed Phenomenological Comparison of Complex Visual Hallucinations in Dementia With Lewy Bodies and Alzheimer's Disease

DLB patients were significantly more likely to experience multiple VH that persisted over follow-up and there were no significant differences in the other phenomenological characteristics including whether the hallucinations moved, the time of day that they were experienced, their size, the degree of insight, and whether they were complete.

Evidence of a Monoaminergic‐Cholinergic Imbalance Related to Visual Hallucinations in Lewy Body Dementia

Results suggest that an imbalance between monaminergic and cholinergic transmitters is involved in hallucinogenesis in the human brain.

Longitudinal outcome of Parkinson’s disease patients with psychosis

It appears the prognosis has improved with atypical antipsychotic therapy based on the finding that 28% of NH patients died within 2 years compared with 100% in a previous study done prior to availability of this treatment.

Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence.

Of the agents reviewed, the atypical antipsychotics risperidone and olanzapine currently have the best evidence for efficacy, however, the effects are modest and further complicated by an increased risk of stroke.

Dementia associated with Parkinson's disease

  • M. Emre
  • Psychology, Biology
    The Lancet Neurology
  • 2003

Topography, Extent, and Clinical Relevance of Neurochemical Deficits in Dementia of Lewy Body Type, Parkinson's Disease, and Alzheimer's Disease

Quantitative data suggest that although extrapyramidal symptoms relate to striatal levels of dopamine, cognitive impairment is most closely associated with cholinergic (but not monoaminergic) deficits in temporal and archicortical areas.

Combined effect of age and severity on the risk of dementia in Parkinson's disease

It is suggested that the increased risk of incident dementia in Parkinson's disease associated with age and severity of extrapyramidal signs is related primarily to their combined effect rather than separate effects.