Treatment of Advanced Parkinson's Disease
Currently, rivastigmine, a cholinesterase inhibitor, is the only FDA-approved medication for the treatment of mild to moderate Parkinson's disease dementia (PDD), and rivastigmine is the only agent with efficacy data in PDD. In a double-blind randomized study of 541 patients with PDD (MMSE 10–24), a significant improvement in dementia was seen at 24 weeks. This improvement in PDD was maintained in the extension of this trial, which was a long-term treatment study (up to 48 weeks). In a 76-week randomized open-label study of rivastigmine 12 md/day capsules and 9.5 mg/24 h patch, 583 patients were randomized. The incidence of adverse events due to worsening of Parkinson's disease was 36.1% in the capsule group with tremor being the most frequently reported [24.5%; 95% confidence interval (CI)]. In the patch group, adverse events due to worsening of Parkinson's disease were 31.9%; however, tremor was reported in 9.7% (95% CI). In both groups, there was a 2.1-point worsening on the UPDRS-III motor scale. The efficacy was comparable to results in previous trials. Donepezil, galantamine, and memantine have been evaluated for the treatment of PDD in different trials, but their efficacy has not been clearly demonstrated.
Dementia
Currently, rivastigmine, a cholinesterase inhibitor, is the only FDA-approved medication for the treatment of mild to moderate Parkinson's disease dementia (PDD), and rivastigmine is the only agent with efficacy data in PDD. In a double-blind randomized study of 541 patients with PDD (MMSE 10–24), a significant improvement in dementia was seen at 24 weeks. This improvement in PDD was maintained in the extension of this trial, which was a long-term treatment study (up to 48 weeks). In a 76-week randomized open-label study of rivastigmine 12 md/day capsules and 9.5 mg/24 h patch, 583 patients were randomized. The incidence of adverse events due to worsening of Parkinson's disease was 36.1% in the capsule group with tremor being the most frequently reported [24.5%; 95% confidence interval (CI)]. In the patch group, adverse events due to worsening of Parkinson's disease were 31.9%; however, tremor was reported in 9.7% (95% CI). In both groups, there was a 2.1-point worsening on the UPDRS-III motor scale. The efficacy was comparable to results in previous trials. Donepezil, galantamine, and memantine have been evaluated for the treatment of PDD in different trials, but their efficacy has not been clearly demonstrated.
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