Cholinesterase inhibitors for Parkinson's disease dementia.

Title
Cholinesterase inhibitors for Parkinson's disease dementia.
Source
Cochrane Database of Systematic Reviews. (1):CD004747, 2006.




BACKGROUND:

The loss of cholinergic, dopaminergic and noradrenergic innervations seen in Parkinson's Disease Dementia (PDD) suggest a potential role for cholinesterase inhibitors. Concerns have been expressed about a theoretical worsening of Parkinson's disease related symptoms particularly movement symptoms. OBJECTIVES: To assess the efficacy, safety, tolerability and health economic data relating to the use of cholinesterase inhibitors in PDD.

CONCLUSIONS:

Rivastigmine appears to improve cognition and activities of daily living in patients with PDD. This results in clinically meaningful benefit in about 15% of cases. There is a need for more studies utilising pragmatic measures such as time to residential care facility and both patient and carer quality of life assessments. Future trials should involve other cholinesterase inhibitors, utilise tools to analyse the data that limit any bias and measure health economic factors. It is unlikely that relying solely on the last observation carried forward (LOCF) is sufficient. Publication of the observed case data in the largest trial would assist. Adverse events were associated with the cholinergic activity of rivastigmine, but may limit patient acceptability as evidenced by the high drop out rate in the active arm.