Rivastigmine in the treatment of dementia with Lewy bodies: preliminary findings from an open trial

Abstract

The objective of this study was to assess the tolerability and efficacy of rivastigmine in a group of patients with probable dementia with Lewy bodies (DLB), using an open label study. Open label treatment was with rivastigmine up to maximum tolerated dose (mean 9.6 mg daily, range 3–12 mg). Eleven patients with DLB, mean age 78.5 years, were treated with this cholinesterase inhibitor. After 12 weeks of treatment, mean Neuropsychiatric Inventory scores fell by 73% for delusions, 63% for apathy, 45% for agitation and 27% for hallucinations. Five of the patients (45%) experienced very significant clinical improvements that had not been achieved with other treatments, including low dose neuroleptics. Medication was well tolerated and parkinsonian symptoms tended to improve. Cholinesterase inhibition may be a safe and effective alternative to neuroleptic treatment in DLB. Such effects may also prove to be applicable to the management of neuropsychiatric symptoms in Parkinson's disease and Alzheimer's disease. Copyright © 2000 John Wiley & Sons, Ltd.

Association cortex hypoperfusion in mild dementia with Lewy bodies: a potential indicator of cholinergic dysfunction?

“…Furthermore, we observed both improved CBF and performance on cognitive tests, specifically, tests of verbal fluency. This is consistent with the notion that frontosubcortical dysfunction may be more directly related to cholinergic functioning (Bohnen et al 2005), and observations that symptoms of DLB have a greater response to ChEI treatment than the cognitive symptoms in AD (McKeith et al 2000). Further, PET studies comparing DLB with Parkinson’s disease without dementia suggest that a cholinergic deficit is necessary for the development of cognitive symptoms (Klein et al 2010).…”

Rivastigmine in the treatment of parkinsonian psychosis and cognitive impairment: Preliminary findings from an open trial

“…The cholinesterase inhibitor rivastigmine is now an established licensed treatment primarily for the amnestic aspects of mild or moderate AD, but accumulating evidence suggests that dementia syndromes with prominent neuropsychiatric symptomology may be even more responsive to the agent 21, 22, 24, 25, 38, 39. Our results are very similar to those found in studies using comparable assessments of patients diagnosed with DLB 24, 25.…”

Psychosis due to neurologic conditions

“…Rivastigmine may be useful for the for the treatment of delusions, hallucination, apathy, and agitation in patients with diffuse Lewy body dementia [66,Class IIIa]. Delusions responded more robustly than hallucinations, and parkinsonism was not exacerbated during the 12-week course of this study.…”