Donepezil for cognitive impairment in Parkinson's disease: a randomised controlled study

Aarsland, Dag; Laake, Knut; Jp, Larsen; Janvin, Carmen

doi:10.1136/jnnp.72.6.708

Cited by 309 publications

(209 citation statements)

References 31 publications

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“…However, data from clinical trials of anti-dementia agents in the PD setting have been mixed, with some studies reporting a decrease in hallucinations, 28,29 and others reporting no improvement in neuropsychiatric symptoms. [30][31][32] We also observed, from our weighted analysis, that an estimated 16% of patients receiving treatment for PDP have been prescribed risperidone at some point during their course of care. The observation is a potential point of concern in the clinical management of PDP because risperidone is known to exacerbate PD motor symptoms, increase mortality risk in elderly patients with dementia (a common comorbidity among patients with PD), has known interactions with other atypical antipsychotics and is generally not recommended for use in patients with PD.…”

Section: Discussionmentioning

confidence: 85%

Parkinson’s Disease Psychosis – Patterns of Care and Treatment in the EU-5 from Neurologists’ Perspective

Cook¹,

Suresh²,

Lou³

et al. 2017

European Neurological Review

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Over half of patients with Parkinson’s disease (PD) develop symptoms of psychosis during the course of their disease. Existing guidelines include recommendations for managing symptoms of psychosis in patients with PD. However, the extent to which such recommendations translate to clinical practice in major European nations is unclear. The current study describes trends in the clinical management of patients diagnosed with PD psychosis (PDP) based on survey responses and patient chart reviews from 437 neurologists across France, Germany, Italy, Spain, and the UK (collectively, the EU-5). Surveyed neurologists reported that PDP typically manifests four or more years after the diagnosis of PD, with the most commonly reported initial symptoms being moderately disruptive visual hallucinations, agitation, and illusions/false sense of presence. PD medications adjustment was the most common first-line intervention, applicable to an estimated 59–79% of patients for the initial management of PDP depending on country. Responses from surveyed neurologists suggest PD medications adjustment is a temporary solution for many patients with PDP and that there is considerable variability in subsequent lines of intervention. The current report provides a resource for understanding the patterns of care and treatment for PDP across these major European nations.

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Section: Discussionmentioning

confidence: 85%

Parkinson’s Disease Psychosis – Patterns of Care and Treatment in the EU-5 from Neurologists’ Perspective

Cook¹,

Suresh²,

Lou³

et al. 2017

European Neurological Review

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“…This early form is referred to as mild cognitive impairment, a terminology utilized in the Alzheimer literature as well. The reported prevalence of cognitive decline in PD is highly variable, ranging from 10 to 90%, while dementia affects about 30-40% of PD patients, although some studies indicate that dementia is as frequent as nearly 80% (Aarsland et al, 2002;Wood et al, 2010). The risk of dementia significantly increases with age.…”

Section: Therapeutics For Nonmotor Symptoms Of Pdmentioning

confidence: 99%

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Smith

Wichmann

Factor

et al. 2011

Neuropsychopharmacol

194

137

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The demonstration that dopamine loss is the key pathological feature of Parkinson's disease (PD), and the subsequent introduction of levodopa have revolutionalized the field of PD therapeutics. This review will discuss the significant progress that has been made in the development of new pharmacological and surgical tools to treat PD motor symptoms since this major breakthrough in the 1960s. However, we will also highlight some of the challenges the field of PD therapeutics has been struggling with during the past decades. The lack of neuroprotective therapies and the limited treatment strategies for the nonmotor symptoms of the disease (ie, cognitive impairments, autonomic dysfunctions, psychiatric disorders, etc.) are among the most pressing issues to be addressed in the years to come. It appears that the combination of early PD nonmotor symptoms with imaging of the nigrostriatal dopaminergic system offers a promising path toward the identification of PD biomarkers, which, once characterized, will set the stage for efficient use of neuroprotective agents that could slow down and alter the course of the disease.

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“…Regarding neurochemical substrates in PDD, recent pathologic and functional studies have suggested that cholinergic deficits were significantly correlated with cognitive dysfunction in patients with PD (7)(8)(9). Various kinds of cholinesterase inhibitors (ChEIs), including rivastigmine (10), donepezil (11), and galantamine (12), have proven to be effective in improving cognitive function in patients with PDD, supporting this theory.…”

mentioning

confidence: 86%

Changes in Cerebral Glucose Metabolism in Patients with Parkinson Disease with Dementia After Cholinesterase Inhibitor Therapy

Lee¹,

Yong²,

An³

2008

J Nucl Med

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We investigated changes in cerebral glucose metabolism after cholinesterase inhibitor (ChEI) therapy in patients with Parkinson disease dementia (PDD) to determine whether cognitive improvements would be reflected in changes of cerebral metabolic patterns, thus offering insight into the neural substrate of cognitive dysfunction in patients with PDD. Methods: We performed a serial PET study before (baseline) and after ChEI therapy on 10 patients with PDD, using statistical parametric mapping. Additionally, covariance analysis was performed to extract regions in which increased change in regional cerebral metabolism correlated significantly with increased Mini-Mental State Examination scores. Results: The statistical parametric mapping analysis indicated that significantly increased cerebral metabolism after ChEI therapy, compared with at baseline, was most evident in the left angular gyrus extending to the supramarginal area and left superior and middle frontal gyri. Additionally, cerebral metabolism was significantly increased in the right superior frontal and left middle orbitofrontal gyri. In contrast, the right fusiform gyrus showed significantly decreased metabolism after ChEI, compared with at baseline. In the correlation analysis, improvements in Mini-Mental State Examination scores after ChEI treatment were significantly associated with increased cerebral metabolism in the left supramarginal, orbitofrontal, and cingulate areas. Conclusion: Our data suggest that prefrontal and parietal association areas may be relevant structures for the pharmacologic response to ChEI in patients with PDD. Cogni tive dysfunction occurs in 25%230% of patients with Parkinson disease (PD); this prevalence is 6 times greater than that among the population in general (1-3). The key feature of dementia in PD is executive dysfunction; thus, patients with PD dementia (PDD) have difficulty in tasks that require generation of mental sets, planning, and cognitive sequencing. Additionally, patients with PDD often exhibited worse performance in visuospatial tasks and memory impairment in free recalls, which improved significantly with external cues, suggesting that these patients still had the ability to store new information (3,4).Although the exact pathophysiologic substrate in PDD is still controversial, progressive involvement of subcortical and cortical structures, by Lewy-type pathology or Alzheimer disease-like histologic changes, has been suggested (5,6). Regarding neurochemical substrates in PDD, recent pathologic and functional studies have suggested that cholinergic deficits were significantly correlated with cognitive dysfunction in patients with PD (7-9). Various kinds of cholinesterase inhibitors (ChEIs), including rivastigmine (10), donepezil (11), and galantamine (12), have proven to be effective in improving cognitive function in patients with PDD, supporting this theory.Only 1 study, which used SPECT, reported that ChEIs significantly increased cerebral perfusion in frontal and cingulate areas (13). However, images ob...

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Donepezil for cognitive impairment in Parkinson's disease: a randomised controlled study

Cited by 309 publications

References 31 publications

Parkinson’s Disease Psychosis – Patterns of Care and Treatment in the EU-5 from Neurologists’ Perspective

Parkinson’s Disease Psychosis – Patterns of Care and Treatment in the EU-5 from Neurologists’ Perspective

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Changes in Cerebral Glucose Metabolism in Patients with Parkinson Disease with Dementia After Cholinesterase Inhibitor Therapy

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