Rivastigmine for Dementia Associated with Parkinson's Disease

Emre, Murat; Aarsland, Dag; Albanese, Alberto; Byrne, E. Jane; Deuschl, Günther; Deyn, PP De; Durif, Franck; Kulisevsky, Jaime; Laar, Teus van; Lees, A. J.; Poewe, Werner; Robillard, Alain; Rosa, M. M.; Wolters, Erik Ch.; Quarg, Peter; Tekin, Sibel; Lane, Roger

doi:10.1056/nejmoa041470

Cited by 1,098 publications

(806 citation statements)

References 30 publications

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“…The frequent use of antidementia agents may have been driven, in part, by comorbid dementia, as approximately half of the charts from patients with PDP who received anti-dementia agents during their course of care also reported the comorbidity. 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.…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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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“…The frequency and severity of psychiatric symptoms in the PDD group were even higher than those reported in clinical trials for PDD (17,18) and the distribution of psychiatric symptoms differed markedly between PDD patients and patients with moderate to severe AD (19), including our own cohort (20). Hallucinations were more severe in PD patients, while aberrant motor behaviour, agitation, disinhibition, irritability and euphoria were more severe in AD.…”

Section: Discussionmentioning

confidence: 50%

Neuropsychiatric symptoms and associated caregiver stress in geriatric patients with Parkinson’s disease

2015

neurol neurosci

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Objectives: In Parkinson´s disease, researchers are becoming increasingly aware of the need to include the assessment of behavioural and psychological symptoms as important outcome measures in clinical trials. Besides, clinicians are starting to recognise the need to identify and manage these symptoms in addition to the motor ones. Our objective is to explore the presence of neuropsychiatric symptoms in geriatric patients with Parkinson and the associated distress in their caregivers.Methods: 100 patients with PD ageing 75 years old or more (50 PD without dementia and 50 PD Dementia (PDD) were assessed using the 10-item Neuropsychiatric Inventory-questionnaire (NPI-Q), and the NPI Caregiver Distress Scale (NPI-D). Results:The mean total NPI score was 12.9. At least one neuropsychiatric symptom was present in more than 80% of participants. Within PDD patients about 89% suffered at least one NPI symptom, 70% suffered at least 2 symptoms and one of those symptoms had an intensity scoring 4 of higher in more than 50%. Numbers in PD patients without dementia were significantly lower, though more than 50% of patients had at least 2 symptoms. The most frequent symptom was depression, followed by apathy, anxiety, depression and hallucinations. Antiparkinsonian agents can exacerbate psychotic symptoms. Nearly 60% of caregivers reported suffering a moderate to severe level of stress due to these symptoms. Symptoms causing more stress were agitation/aggression followed by hallucinations and irritability/lability. Conclusions:Neuropsychiatric symptoms are frequent in geriatric patients with PD -specially in patients with PDD-and lead to moderate to severe caregiver distress.

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“…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

Lepkowsky¹

2017

IJGS

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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].

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Rivastigmine for Dementia Associated with Parkinson's Disease

Cited by 1,098 publications

References 30 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

Neuropsychiatric symptoms and associated caregiver stress in geriatric patients with Parkinson’s disease

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

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