Effects of Rivastigmine in Alzheimer's Disease Patients with and Without Hallucinations

Cummings, Jeffrey L.; Emre, Murat; Aarsland, Dag; Tekin, Sibel; Dronamraju, Nalina; Lane, Roger

doi:10.3233/jad-2010-1362

Cited by 17 publications

(9 citation statements)

References 32 publications

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“…An accurate collection and analysis of data on these clinical phenomena, besides contributing to a better understanding of their pathogenesis, may be useful in a clinical setting and in decision-making about therapy, as posed by recent evidence about a different efficacy of cholinesterase inhibitors in v-HALL and N-HALL subjects [46]. …”

Section: Discussionmentioning

confidence: 99%

Cognitive and Behavioral Determinants of Psychotic Symptoms in Alzheimer's Disease

Quaranta¹,

Vita²,

Bizzarro³

et al. 2015

Dement Geriatr Cogn Disord

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Aims: To investigate the relationship between psychotic symptoms and cognitive impairment in Alzheimer's disease (AD). Methods: A total of 108 subjects affected by AD were subdivided into subjects without delusions (ND), subjects with paranoid delusions (PD), subjects with delusional misidentifications (DM), subjects with both DM and PD (DM+PD), subjects with visual hallucinations (v-HALL), and subjects without visual hallucinations (N-HALL). Results: PD and ND subjects performed similarly on neuropsychological tests, while DM patients performed significantly worse than PD and ND patients. v-HALL patients performed worse than N-HALL patients on memory, visuospatial, and executive functions. As for behavioral features, DM and v-HALL subjects reported higher scores on the abnormal motor behavior subscale of the neuropsychiatric inventory (NPI); PD subjects reported higher scores on the disinhibition subscale of the NPI. The severity of PD was predicted by the severity of disinhibition (B = 0.514; p = 0.016) but not by neuropsychological performances. The severity of DM was predicted by age (B = 0.099; p = 0.048) and MMSE (B = -0.233; p = 0.001). The severity of v-HALL was predicted by age (B = 0.052; p = 0.037) and scores on an immediate visual memory task (B = -0.135; p = 0.007). Conclusions: The occurrence of PD may require the relative sparing of cognitive functions and be favored by frontal lobe dysfunction, while DM is associated with the overall level of cognitive impairment. Finally, v-HALL are associated with the impairment of visuospatial abilities.

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Section: Discussionmentioning

confidence: 99%

Cognitive and Behavioral Determinants of Psychotic Symptoms in Alzheimer's Disease

Quaranta¹,

Vita²,

Bizzarro³

et al. 2015

Dement Geriatr Cogn Disord

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“…Rivastigmine was more effective in the hallucinator group. 162 Several trials have been conducted on combinations of ChEIs with other drugs. In depressed AD patients, combined treatment of ChEIs (67% of patients donepezil, 20% rivastigmine, 13% galantamine) with serotonin reuptake inhibitors (citalopram, escitalopram, sertraline, fluoxetine, paroxetine) was compared with ChEI treatment only in depressed and non-depressed persons, over 9 months with individually escalating ChEI doses.…”

Section: Clinical Studiesmentioning

confidence: 99%

Cognitive Enhancers in Moderate to Severe Alzheimer's Disease

Hardeland

2011

Clinical Medicine Insights: Therapeutics

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The treatment of moderate to severe Alzheimer's disease is reviewed with regard to mechanisms of action, pharmacokinetics, metabolism, safety/tolerability, and efficacy in reducing cognitive, behavioral/psychiatric, functional and global symptoms. The cholinesterase inhibitors donepezil, rivastigmine and galantamine and the N-methyl-d-aspartate receptor channel blocker memantine are moderately beneficial. Small improvements over a few months are followed by slowed mental decline. Concerning cognitive, functional and global functions, these drugs are similarly effective. Cholinesterase inhibitors also reduce apathy, memantine counteracts agitation and aggression. Serious adverse effects are rare with all four drugs. Cholinesterase inhibitors bear a risk for patients with cardiac diseases. Adverse emetic events are typical for oral formulations of these drugs, but less for rivastigmine transdermal patches. Other routes of administration and use of a galantamine prodrug are currently investigated. The superiority of combination therapies over monotherapies requires further support. Promising investigational drugs include the copper/zinc ionophore PBT2 and multifunctional hybrid molecules.

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“…Individualized treatment rules are increasingly being used by clinical and intervention scientists to account for patient response heterogeneity (e.g., Ludwig & Weinstein, 2005; Hayes et al, 2007; Allegra et al, 2009; Cummings et al, 2010). These treatment rules belong to the new era of personalized medicine (Piquette-Miller & Grant, 2007; Hamburg & Collins, 2010).…”

Section: Introductionmentioning

confidence: 99%

Tree-based methods for individualized treatment regimes

Laber

Zhao²

2015

Biometrika

171

176

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Summary Individualized treatment rules recommend treatments on the basis of individual patient characteristics. A high-quality treatment rule can produce better patient outcomes, lower costs and less treatment burden. If a treatment rule learned from data is to be used to inform clinical practice or provide scientific insight, it is crucial that it be interpretable; clinicians may be unwilling to implement models they do not understand, and black-box models may not be useful for guiding future research. The canonical example of an interpretable prediction model is a decision tree. We propose a method for estimating an optimal individualized treatment rule within the class of rules that are representable as decision trees. The class of rules we consider is interpretable but expressive. A novel feature of this problem is that the learning task is unsupervised, as the optimal treatment for each patient is unknown and must be estimated. The proposed method applies to both categorical and continuous treatments and produces favourable marginal mean outcomes in simulation experiments. We illustrate it using data from a study of major depressive disorder.

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Effects of Rivastigmine in Alzheimer's Disease Patients with and Without Hallucinations

Cited by 17 publications

References 32 publications

Cognitive and Behavioral Determinants of Psychotic Symptoms in Alzheimer's Disease

Cognitive and Behavioral Determinants of Psychotic Symptoms in Alzheimer's Disease

Cognitive Enhancers in Moderate to Severe Alzheimer's Disease

Tree-based methods for individualized treatment regimes

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