Role of Cholinesterase Inhibitors in Parkinson’s Disease and dementia with Lewy Bodies

Aarsland, Dag; Mosimann, Urs Peter; McKeith, Ian G.

doi:10.1177/0891988704267463

Cited by 165 publications

(91 citation statements)

References 61 publications

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“…These reports are summarised in a review by Aarsland and colleagues. 29 Despite their methodological limitations with regard to study designs and small sample sizes, an overall evaluation of these studies suggests that treatment with ChE-I provides an improvement in cognition as well as behavioural symptoms in most patients, without having a detrimental effect on motor functions in the majority of patients.…”

Section: Biochemical Deficits and Treatment Of Parkinson's Disease Dementioning

confidence: 99%

Dementia Associated with Parkinsons Disease

Emre¹

2007

European Neurological Review

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The classical perception of Parkinson's disease (PD) heavily emphasises its motor aspects, cognitive features and dementia associated with the disease being largely ignored. Epidemiological studies performed in the last few decades revealed the substantially high incidence and prevalence of cognitive impairment and dementia in PD. Clinical studies using EpidemiologyDementia associated with PD has been increasingly better recognised, probably because patients with PD survive for longer than before thanks to modern treatment. Although subtle cognitive deficits can be found in newly diagnosed patients with PD, 1 dementia itself is strongly associated with advanced age and severe disease. 2 In population-based, cross-sectional studies the prevalence of dementia has been reported to be 28-41%. A meta-analysis of 12 carefully selected studies revealed a cross-sectional prevalence of close to 30%. 3 The incidence increases up to six-fold and the cumulative incidence over eight years of follow-up was described to be 78%. 4,5 The longitudinal Sydney study revealed that 15 years after the diagnosis 85% of the patients had cognitive impairment, with 50% fulfilling

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Section: Biochemical Deficits and Treatment Of Parkinson's Disease Dementioning

confidence: 99%

Dementia Associated with Parkinsons Disease

Emre¹

2007

European Neurological Review

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“…2,3 Nevertheless, the accurate identification and differentiation of DLB and AD is particularly important as this affects patient management. Those with DLB exhibit adverse sensitivity to neuroleptics, a positive response to cholinesterase inhibitors especially for noncognitive symptoms 4 and, compared with AD, a different prognosis. 5,6 Methods that can improve the diagnostic accuracy of DLB and AD are therefore of great value.…”

Section: Introductionmentioning

confidence: 99%

Multivariate Spatial Covariance Analysis of ^99MTc-Exametazime SPECT Images in Dementia with Lewy Bodies and Alzheimer'S Disease: Utility in Differential Diagnosis

Colloby

Taylor

Davison

et al. 2013

J Cereb Blood Flow Metab

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We examined 99m Tc-exametazime brain blood flow single-photon emission computed tomography (SPECT) images using a spatial covariance analysis (SCA) approach to assess its diagnostic value in distinguishing dementia with Lewy bodies (DLB) from Alzheimer's disease (AD). Voxel SCA was simultaneously applied to a set of preprocessed images (AD, n ¼ 40; DLB, n ¼ 26), generating a series of eigenimages representing common intercorrelated voxels in AD and DLB. Linear regression derived a spatial covariance pattern (SCP) that discriminated DLB from AD. To investigate the diagnostic value of the model SCP, the SCP was validated by applying it to a second, independent, AD and DLB cohort (AD, n ¼ 34; DLB, n ¼ 29). Mean SCP expressions differed between AD and DLB (F 1,64 ¼ 36.2, Po0.001) with good diagnostic accuracy (receiver operating characteristic (ROC) curve area 0.87, sensitivity 81%, specificity 88%). Forward application of the model SCP to the independent cohort revealed similar differences between groups (F 1,61 ¼ 38.4, Po0.001), also with good diagnostic accuracy (ROC 0.86, sensitivity 80%, specificity 80%). Multivariate analysis of blood flow SPECT data appears to be robust and shows good diagnostic accuracy in two independent cohorts for distinguishing DLB from AD.

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“…Accordingly cholinesterase inhibitor drugs may be an appropriate therapy in treating cognitive decline. The current evidence suggests cholinesterase inhibitors may be effective in treating mild to moderate dementia in PD particularly in those with visual hallucinations, behavioural disorders and psychosis [Burn et al 2006;Aarsland et al 2004]. Not all patients benefit and a significant number of patients experience side effects such as tremor or vomiting necessitating dose reduction or withdrawal.…”

Section: Therapeutic Advances In Chronic Disease 2 (2)mentioning

confidence: 99%

Evaluation and management of the non-motor features of Parkinson’s disease

Wishart

Macphee

2010

Therapeutic Advances in Chronic Disease

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Parkinson's disease (PD) is traditionally viewed as a motor disorder with a characteristic triad of tremor, rigidity and bradykinesia. There is now increasing awareness that PD is a complex systemic disorder with many nonmotor symptoms (NMS) which include autonomic dysfunction, sleep disorders, sensory and neuropsychiatric features. NMS become more common in severity and frequency with advancing disease when neuropsychiatric features such as cognitive impairment and psychosis dominate the clinical picture. NMS are strongly correlated with quality of life for patients and their families as well as institutional care placement. Despite their importance, NMS are poorly recognized by clinicians and often undeclared by patients. Use of a validated screening tool NMSQuest followed by specific symptom assessment instruments strengthens the recognition and holistic management of NMS in PD. Some NMS such as mood disturbance, anxiety, pain and insomnia may be improved by optimization of dopaminergic therapy. Conversely, psychosis, excess daytime somnolence or impulse control disorder (ICD) may be triggered by dopaminergic drugs. Other NMS such as dementia and severe depression may be unresponsive to dopaminergic treatment and may reflect perturbations in cholinergic, serotonergic or noradrenergic neurotransmitter function. These symptoms are more challenging to manage but may be ameliorated to some extent by agents such as acetylcholinesterase inhibitor or antidepressant drugs. This contribution reviews the evidence for the evaluation and management of key NMS in PD (apathy, anxiety, depression, psychosis, dementia, ICD, sleep disturbance, autonomic dysfunction, pain) and highlights the urgent need for both novel therapies and more controlled trials for current therapeutic strategies.

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Role of Cholinesterase Inhibitors in Parkinson’s Disease and dementia with Lewy Bodies

Cited by 165 publications

References 61 publications

Dementia Associated with Parkinsons Disease

Dementia Associated with Parkinsons Disease

Multivariate Spatial Covariance Analysis of ^99MTc-Exametazime SPECT Images in Dementia with Lewy Bodies and Alzheimer'S Disease: Utility in Differential Diagnosis

Evaluation and management of the non-motor features of Parkinson’s disease

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Role of Cholinesterase Inhibitors in Parkinson’s Disease and dementia with Lewy Bodies

Cited by 165 publications

References 61 publications

Dementia Associated with Parkinsons Disease

Dementia Associated with Parkinsons Disease

Multivariate Spatial Covariance Analysis of 99MTc-Exametazime SPECT Images in Dementia with Lewy Bodies and Alzheimer'S Disease: Utility in Differential Diagnosis

Evaluation and management of the non-motor features of Parkinson’s disease

Contact Info

Product

Resources

About

Multivariate Spatial Covariance Analysis of ^99MTc-Exametazime SPECT Images in Dementia with Lewy Bodies and Alzheimer'S Disease: Utility in Differential Diagnosis