Rivastigmine for mild cognitive impairment in Parkinson disease: A placebo‐controlled study

Mamikonyan, Eugenia; Xie, Sharon X.; Melvin, Emilie; Weintraub, Daniel

doi:10.1002/mds.26236

Cited by 92 publications

(84 citation statements)

References 39 publications

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“…In the first trial in PD-MCI, rivastigmine patch offered some benefit, although the primary outcome measure — clinical impression of change — was not significantly affected 182 . However, significant effects were observed on one of the secondary outcomes, a scale measuring everyday cognitive activities.…”

Section: Managementmentioning

confidence: 97%

Cognitive decline in Parkinson disease

et al. 2017

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Dementia is a frequent problem encountered in advanced stages of Parkinson disease (PD). In recent years, research has focused on the pre-dementia stages of cognitive impairment in PD, including mild cognitive impairment (MCI). Several longitudinal studies have shown that MCI is a harbinger of dementia in PD, although the course is variable, and stabilization of cognition — or even reversal to normal cognition — is not uncommon. In addition to limbic and cortical spread of Lewy pathology, several other mechanisms are likely to contribute to cognitive decline in PD, and a variety of biomarker studies, some using novel structural and functional imaging techniques, have documented in vivo brain changes associated with cognitive impairment. The evidence consistently suggests that low cerebrospinal fluid levels of amyloid-β42, a marker of comorbid Alzheimer disease (AD), predict future cognitive decline and dementia in PD. Emerging genetic evidence indicates that in addition to the APOE*ε4 allele (an established risk factor for AD), GBA mutations and SCNA mutations and triplications are associated with cognitive decline in PD, whereas the findings are mixed for MAPT polymorphisms. Cognitive enhancing medications have some effect in PD dementia, but no convincing evidence that progression from MCI to dementia can be delayed or prevented is available, although cognitive training has shown promising results.

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Section: Managementmentioning

confidence: 97%

Cognitive decline in Parkinson disease

et al. 2017

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“…Acetylcholinesterase inhibitors (ACHEIs) improve cognition by increasing cholinergic activity, and include the most widely used dementia drug in the world, donepezil, 6 as well as rivastigmine 7,8 and galantamine. 9,10 Drugs which block cholinergic transmission/ have anticholinergic (ACH) activity, are prescribed by all clinical specialties, and include some of the most commonly used drugs in the United States such as oxybutynin, paroxetine, and diphenhydramine.…”

Section: Introductionmentioning

confidence: 99%

Patterns of Dementia Treatment and Frank Prescribing Errors in Older Adults With Parkinson Disease

et al. 2019

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Importance: Dementia is common in Parkinson disease (PD), but there is little data on dementia treatment patterns or the concomitant use of cholinesterase inhibitors (ACHEI) and anticholinergic medications (ACH), a frank prescribing error. Objective: To determine the prevalence of dementia treatment and to quantify and characterize inappropriate administration of a high-potency ACH (ACHhigh) drug and an ACHEI among persons with PD. Design, Setting and Participants: This cross-sectional analysis included participants in the U.S. Medicare Prescription Program in 2014 diagnosed with Parkinson Disease. Main Outcomes/Measures: Our primary outcomes were (1) prescription fill for a dementia drug (2) concomitant prescription fills for an ACHEI and an ACHhigh drug. Descriptive analyses and multivariable logistic regression models determined the extent to which patient characteristics and comorbid conditions were associated with dementia treatment or with an ACHhigh-ACHEI event. Results: 268,407 Medicare beneficiaries diagnosed with PD met inclusion criteria; 73,093 (27.2%) were prescribed at least one anti-dementia medication. The commonest medication was donepezil (n=46,027; 63.0% of users) followed by memantine (n=30,578, 41.8%), rivastigmine (n=19,278, 26.4%). Compared to whites, dementia medications were more likely to be prescribed to Blacks (adjusted odds ratio [AOR] 1.33, 95% confidence interval [CI] 1.28–1.38) and Hispanics (AOR 1.28, 95%CI 1.22–1.35) and less likely to be prescribed to Native Americans (AOR 0.62, 95%CI 0.51–0.74). Women were less likely to be prescribed a dementia medication (AOR 0.85, 95%CI 0.84–0.87, compared to men). Of the 64,017 PD patients receiving an ACHEI, 44.5% (n=28,495) had at least one ACHhigh-ACHEI event. Hispanics (AOR 1.11, 95%CI 1.00–1.23) and women (AOR 1.30, 95%CI 1.25–1.35) had greater odds of this ‘never event’. There was statistically significant clustering in the prevalence of this prescribing error (Moran’s I = 0.24; p < 0.001), with clusters of high ACHhigh-ACHEI prevalence in the Southern and Midwestern United States. Conclusions and Relevance: Dementia medication use varies by race and sex among persons with PD. Potentially inappropriate prescribing is common among PD patients being treated for cognitive impairment, and varies substantially by race, sex and geography. These data provide national and local targets for improving care quality and outcomes for persons with PD.

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“…Such an approach would be useful in the clinical management of these non-motor symptoms and the identification of neuropsychological subtypes in PD. It has been suggested that cognitively impaired PD patients are more likely to use anti-anxiety medication than those without [5] and that pharmacological treatment of PD-MCI using rivastigmine has been shown to reduce concomitant anxiety [6].…”

Section: Introductionmentioning

confidence: 99%

Anxiety is associated with cognitive impairment in newly-diagnosed Parkinson's disease

Dissanayaka

Lawson

Yarnall

et al. 2017

Parkinsonism & Related Disorders

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IntroductionAnxiety and mild cognitive impairment (MCI) are prevalent non-motor manifestations of Parkinson's disease (PD). While few studies have demonstrated a possible link between cognitive dysfunction and anxiety in PD, to our knowledge, no studies have directly examined the association between them. This study investigated the association between anxiety and cognitive deficits in newly diagnosed PD patients.MethodsPatients with newly diagnosed PD (N = 185) were recruited from community and outpatient clinics. Anxiety was assessed using the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) clinician rated anxiety item, which has previously been validated against a standardized criteria for the diagnosis of anxiety disorders in PD. Participants scoring ≥2 were classified as anxious. A threshold of 1 SD below normative values (obtained from controls) was used to define cognitive impairment. Impairments in specific cognitive domains were identified as being >1 SD below controls in ≥1 test per domain.ResultsAfter controlling for age, education and motor severity, patients with anxiety were three times more likely to have cognitive impairment compared to those without anxiety (OR = 3.0, 95% CI = 1.2–7.3, p < 0.05). Patients with anxiety were more than twice as likely to be classified as having cognitive impairment due to impairment in the memory domain compared with PD without anxiety (OR = 2.3, 95% CI = 1.0–5.1, p < 0.05), whilst no associations were found between anxiety and performance on other cognitive domains.ConclusionThis study shows an association between anxiety and cognitive impairment (specifically memory impairment). Examining the neural basis of this association warrants future research in this developing field.

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Rivastigmine for mild cognitive impairment in Parkinson disease: A placebo‐controlled study

Cited by 92 publications

References 39 publications

Cognitive decline in Parkinson disease

Cognitive decline in Parkinson disease

Patterns of Dementia Treatment and Frank Prescribing Errors in Older Adults With Parkinson Disease

Anxiety is associated with cognitive impairment in newly-diagnosed Parkinson's disease

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