Effects of Rivastigmine on Memory and Cognition in Multiple Sclerosis

Abstract

476Cognitive dysfunction with prominent involvement of memory, sustained attention, executive functions, and information processing speed is a prevalent disabling neuropsychologic symptom of multiple sclerosis (MS) with prevalence of 40-65%.1 It is associated with significant disability and impaired quality of life, adversely affecting daily activity and role fulfillment in work and social life, independently from physical disability, [2][3][4] with profound socioeconomic consequences. Cognitively impaired MS patients experience higher rate of unemployment, 4-6 and divorce 5 than non-impaired MS peers. They are more likely to be involved in accidents, including motor vehicle crashes.7-9 Difficulties in learning and ABSTRACT: Background: Cognitive dysfunction is one of the common clinical symptoms in multiple sclerosis (MS), but there is no effective treatment for it. Objective: The aim of this study was to evaluate the effect of rivastigmine in treating memory and cognitive dysfunction in MS. Methods: A single-center double-blind placebo-controlled randomized clinical trial conducted from October 2005 to February 2007. Sixty definite MS patients with cognitive impairment age 16 to 54 years were randomly allocated to receive a 12-week treatment course of either rivastigmine (1.5 mg once a day increment over 4 weeks to 3 mg twice daily) or placebo. Response to treatment was assessed by the Wechsler Memory Scale (WMS) at baseline and 12 weeks after start of therapy. Results: A slight, but significant memory improvement occurred in both groups. Of the 30 patients treated with rivastigmine, the mean (SD) WMS general memory score increased from 60.3 (4.2) at baseline to 64.9 (5.3) at the end of study period (P<0.001). Correspondingly, in the 30 patients treated with placebo, the mean (SD) WMS general memory score increased from 60.5 (4.9) to 64.5 (3.7) (P < 0.001). The average WMS general memory score at the end of trial did not changed between rivastigmine and placebo group (mean difference, 0.4; 95% CI, -2.0, 2.8). Conclusion: No significant differences were seen between rivastigmine and placebo on the mean (SD) WMS general memory score. A larger multicenter study of rivastigmine in MS is warranted in order to more definitely assess the efficacy of this intervention.RÉSUMÉ: Effets de la rivastigmine sur la mémoire et la cognition dans la sclérose en plaques. Contexte : La dysfonction cognitive est l'un des symptômes cliniques fréquents dans la sclérose en plaques (SEP), pour lequel il n'existe aucun traitement efficace. Objectif : Le but de cette étude était d'évaluer l'effet de la rivastigmine dans le traitement de la dysfonction mnésique et cognitive de la SEP. Méthodes : Nous avons effectué un essai clinique randomisé à double insu, contrôlé par placebo, dans un seul centre entre octobre 2005 et février 2007. Soixante patients atteints de SEP certaine avec atteinte cognitive, âgés de 16 à 54 ans, ont été randomisés à recevoir un traitement par la rivastigmine (1,5 mg une fois par jour avec augmentation progressiv...

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