Speaker: Paul Reading, PhD, Clinical Neurologist, Department of Neurology, Newcastle General Hospital, Newcastle-Upon-Tyne, United Kingdom.
Results from an open-exploratory study point out that the cholinesterase inhibitor rivastigmine (Exelon, Novartis) has a positive effect on the neuropsychiatric complications of Parkinson’s disease (PD), particularly hallucinations and sleep disturbances, and significantly enhances cognitive performance without worsening motor control.
To reach these conclusions, a group of l2 patients with established PD, troublesome hallucinations, and moderate cognitive impairment were enrolled in a l7-week study. The patients underwent eight weeks of titration with rivastigmine to the highest tolerated dose, and were given the drug at that dose for six weeks, after which time the treatment was withdrawn. Cognitive performance was measured by the MMSE (Mini-Mental State Examination) and a computerized neu-ropsychological battery, the CDR battery (Cognitive Drug Research). Neuropsychiatric symptoms and their effects on the caregiver were assessed with the NPI (Neuropsychiatric Inventory). Motor disability was recorded using the UPDRS (Unified Parkinson’s Disease Rating Scale).
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Meeting Highlights: American Academy of Neurology
Neuropsychiatric symptoms and the distress they caused to caregivers, as measured by the NPI, were successfully treated with rivastigmine; patients with hallucinations and sleep disturbances were particularly sensitive to the drug. Cognitive performance measured by the MMSE and CDR battery was also significantly enhanced. There was a non-significant tendency for improvement in motor UPDRS scores. Overall, the drug was well-tolerated.
Acetylcholinesterase Inhibitor For Vascular Dementia Speaker: Raymond D. Pratt, MD, Senior Director and Therapeutic Head, CNS & Internal Medicine, Clinical Research & Development, Eisai Inc., Teaneck, New Jersey.
Findings from a combined analysis of two 24-week, double-blind, randomized, placebo-controlled studies pointed out that donepezil (Generic Aricept, Pfizer/Eisai Inc.), an acetylcholinesterase inhibitor presently indicated for Alzheimer’s disease, significantly improved cognition in patients with both possible and probable vascular dementia.
A total of 1,219 patients with probable (873 patients) or possible (326 patients) vascular dementia, according to NINDS-AIREN (National Institute of Neurological Diseases and Stroke—Association International pour le Recherche et l’Enseignment en Neuro-sciences) criteria, were enrolled into the two studies and randomly assigned to receive placebo, donepezil 5 mg, or donepezil 10 mg daily (5 mg for the first 28 days), for 24 weeks. In these patients, donepezil treatment, either 5 or 10 mg, resulted in beneficial treatment effects on cognition from week six onward, as assessed by the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog). The results obtained using the Mini-Mental State Examination (MMSE), a measure of cognitive function, confirmed the significant benefits of donepezil treatment on cognition, with significant improvements from baseline scores. In patients administered donepezil 10 mg/day, a greater improvement in cognition was shown in those with probable vascular dementia than among those with possible vascular dementia. In an assessment of global function, a significantly larger number of patients with probable vascular dementia demonstrated improvement on donepezil, compared to placebo, as measured by the Clinician’s Interview-Based Impression of Change-plus (CIBIC-plus). Also, in patients with possible vascular dementia, a greater proportion of those on donepezil demonstrated improvement or no change, compared to placebo, as measured by CIBIC-plus. Overall, although results from this analysis indicate that the rates of cognitive decline might vary somewhat in probable and possible vascular dementia, donepezil is nevertheless an effective treatment for the cognitive symptoms of both possible and probable vascular dementia.