Rivastigmine for the treatment of Parkinson’s disease dementia

Abstract

Dementia is a common and important complication of Parkinson’s disease (PD), and adequate treatment is of great importance. Evidence from one large randomized controlled trial and three open-label studies suggest that rivastigmine can improve cognitive functioning and activities of daily living in PD dementia. The randomized controlled trial showed that significantly more patients treated with rivastigmine have a clinically meaningful improvement (40.8%) compared to those treated with placebo (29.7%). In addition, effect has also been demonstrated on tests of executive functioning and attention, and on neuropsychiatric symptoms. Adverse events owing to peripheral cholinergic stimulation, such as nausea and vomiting, were reported by 15–30% of PD patients receiving rivastigmine capsules compared with 2–10% in those taking placebo, and 10% reported worsening of tremor on rivastigmine compared with 4% in the placebo group in the large randomized controlled trial. These adverse events occurred mainly during the titration phase and serious side effects were rare.