An Unusual Case of Nightmares With Galantamine

2019

Constipation

α-Synuclein "Lewy body" pathology is the basis of Parkinson's disease (PD) and neurocognitive disorder with Lewy bodies (NCDLB), sometimes called Lewy body dementia. In patients with α-synuclein pathology, constipation, obstipation and impaction are almost universal symptoms, whose treatment represents a significant burden on health care economies. Description is given of the specific mechanisms through which α-synuclein pathology induces these symptoms, and through which the use of acetylcholinesterase inhibitors (AChEIs) might significantly reduce them. Four case studies are presented testing the hypothesis that the use of the cholinergic agonist donepezil might reduce the symptom of constipation in four patients with NCDLB or PD at different stages of disease progression. Outcomes are presented, as well as follow-up data at 6-, 12-, and 18-month intervals. The potential use of donepezil to reduce the symptoms of constipation in patients with α-synuclein pathology is discussed.

Section: Case Study #2mentioning

confidence: 99%

Prevalence and Treatment of Constipation in Patients with Alpha-Synuclein Pathology

2019

Constipation

“…These can include diarrhea, loss of appetite, muscle cramps, nausea, trouble in sleeping, unusual tiredness or weakness, and vomiting, with less common side effects including abnormal dreams, constipation, dizziness, drowsiness, fainting, frequent urination, headache, joint pain, stiffness, or swelling, mental depression, pain, unusual bleeding or bruising, and weight loss (Pfizer US Pharmaceuticals, 2016). AChEIs including Donepezil also have the potential for rare but potentially dangerous side effects, including muscle breakdown (rhabdomyolysis) and a neurological disorder called neuroleptic malignant syndrome (NMS) [80][81][82][83][84][85][86].…”

Section: Discussionmentioning

confidence: 99%

“…Rivastigmine has been shown to reduce neuropsychiatric symptoms and improve cognitive function as measured by the Mini-Mental State Exam (MMSE) in patients with NCDLB [67][68][69][70][71]. However, in PD patients, improvements in cognition with Rivastigmine have also been associated with higher rates of nausea, vomiting, and tremor (Rare, potentially dangerous side effects of cholinergic agonists include rhabdomyolysis and neuroleptic malignant syndrome (NMS) [80][81][82][83][84][85][86].) [72].…”

Section: Symptom Treatment Of Cholinergic Lewy Pathologymentioning

confidence: 99%

Mechanisms of α‐Synuclein Pathology and Treatment in the Enteric Nervous System

2017

IJGS

Abstractα-synuclein (Lewy Body) pathology is commonly found in the enteric nervous system (ENS) of patients diagnosed with Neurocognitive Disorder with Lewy Bodies (NCDLB) and Parkinson's Disease (PD). Lewy pathology in the ENS can produce symptoms of bowel immotility, including constipation, obstipation, and bowel impaction. These symptoms significantly reduce the quality of life for the patient, producing hardship for the patient and care providers. In Lewy body patients, medical intervention using acetylcholinesterase inhibitors (AChEIs) can significantly reduce or alleviate bowel immotility. The specific mechanism through which the cholinergic agonist Donepezil mitigates Lewy Body bowel immotility is explained. Practice, 1143 Deer Trail Lane, Solvang, California 93463, USA, Tel: 805-688-1229 Fax: 805-686-9382; E-mail: clepkowsky@gmail.com of α-synuclein aggregates in the MP predates cognitive and motor functional manifestations of Lewy body diseases so consistently that it has been nominated as a potential biomarker for Lewy pathology [10,17,30]. Symptomatic Manifestations of Cholinergic Lewy Pathology in the ENSLewy body cholinergic impairment in the ENS manifests symptomatically as gastric immotility and constipation [13,[31][32][33][34][35][36][37][38][39][40][41]. Increased colonic transit time and impaired gastric emptying are frequently found in PD patients [35,42]. The prevalence of constipation in PD is at least three times that of the general population, leading some researchersto suggest that constipation might be a universal feature of PD [47,48]. Bowel immotility can occur 20 years before diagnosis of PD or NCDLB, suggesting that it might be a prodromal symptom for both disorders [5,19,36,44,[49][50][51][52].As α-synuclein pathology advances in the ENS, symptoms of gastric immotility advance from constipation to obstipation and impaction. Escalating gastric immotility in PD and NCDLB can interfere with mobility, sleep, cognition, and mood, increasing the cost of care, and potentially debilitating and/or dramatically reducing the quality of life for patients. [4,34,36,[53][54][55][56] Potential Exacerbation of ENS Symptoms by AntiParkinson MedicationLPD and NCDLB patients with significant Parkinsonian motoric/gait features are often prescribed L-dopa agents like Carbidopa-Levodopa (known also by the brand names Sinemet and Stalevo) in order to preserve gait, balance, and other basic motor functions [40,57,58]. Carbidopa-Levodopa's potential side effects include constipation [59]. which can complicate or exacerbate gastric immotility due to ENS Lewy pathology. Medications frequently used for the treatment of resting tremor in PD and NCDLB includeTrihexyphenidyl (marketed as Artane or Trihex) and Benztropinemesylate (marketed as Cogentin), identified as definite anticholinergics that can also exacerbate gastric immotility through suppression of the cholinergic neurotransmitter pathways innervating the ENS [58,[60][61][62].

“…The potential cognitive benefit of Aricept must be considered against its potential side effects, including diarrhea, loss of appetite, muscle cramps, nausea, trouble in sleeping, unusual tiredness or weakness, and vomiting, with less common side effects including abnormal dreams, constipation, dizziness, drowsiness, fainting, frequent urination, headache, joint pain, stiffness, or swelling, mental depression, pain, unusual bleeding or bruising, and weight loss (Pfizer Pharmaceuticals, 2015). More recent research has also indicated rare but potentially dangerous side effects, including muscle breakdown (rhabdomyolysis) and a neurological disorder called neuroleptic malignant syndrome (Babic & Zurak, 1999; Bourke & Druckenbrod, 1998; Hashimoto, Imamura, Tanimukai, Kazui, & Mori, 2000; Iraqi & Hughes, 2009; “Alzheimer’s drug Aricept,” 2015; Onofrj & Thomas, 2003; Rozzini et al, 2004).…”

Section: Treatment Of Ncdlbmentioning

confidence: 99%

Neurocognitive disorder with Lewy bodies: Evidence-based diagnosis and treatment.

2016

Practice Innovations

The objective was to define the role of the general-practitioner-psychologist in early identification of neurocognitive disorder with Lewy bodies (NCLDB), referral, treatment team coordination, and how these efforts might contribute to improved quality of life for the patient and reduced cost to the economy. Current research was reviewed addressing the prevalence, definition, diagnosis, treatment, and health care cost of NCLDB, as well as the general-practitioner-psychologist's and specialists' roles in diagnosis and treatment. The general-practitioner-psychologist can identify prodromal symptoms of NCDLB, make referrals for most accurate diagnosis, and suggest symptom-specific interventions. Our understanding of NCDLB is nascent and rapidly expanding. The general-practitioner-psychologist might be uniquely positioned to help ensure early NCDLB diagnosis, leading to earlier intervention and better outcomes, with benefit to the patient and the economy.