Rivastigmine in the Treatment of Alzheimer’s Disease and Parkinson’s Disease Dementia

Rivastigmine in the Treatment of Alzheimer’s Disease and Parkinson’s Disease Dementia

Emre Murat

Murat Emre

European Psychiatric Review 2008;1(1):28-32

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Recent epidemiological evidence suggests a worldwide prevalence of 24.3 million cases of dementia, with one new case developing every seven seconds.1 Alzheimer’s disease (AD) remains the most common cause of dementia, responsible for 60–70% of cases in Europe.2 In addition, around 30% of patients with Parkinson’s disease (PD) are affected by dementia.3 In a 12-year population study of patients with PD, the cumulative incidence of dementia increased steadily with age and disease duration, reaching 80% by the age of 90 years (conditional on survival).4

Although it was previously thought that the dementia seen in PD originates from the same pathology that causes AD, recent evidence suggests that the pathologies underlying AD and dementia associated with PD (PDD) are different.5 While the presence of amyloid plaques and neurofibrillary tangles is characteristic of the pathology of AD, PDD has been found to be predominantly associated with Lewy body-type pathology.3 Moreover, the pathological course of the disease is different in the two dementia types, with AD typically starting in the entorhinal and transentorhinal regions and PDD starting in the brainstem. 5,6 The different brain areas affected are also reflected in the distinct clinical profiles of PDD and AD: AD is primarily characterised by memory deficits,6whereas PDD typically manifests as a dysexecutive syndrome with a predominant impairment of executive functions and attention. 3

Despite these differences, cholinergic deficits are a common feature in both AD and PDD.7 The original hypothesis, developed to explain the symptoms seen in AD,8 suggests that the cognitive impairments seen in dementia are biochemically associated with cholinergic deficits. However, it has since been described that cholinergic deficits in patients with PDD may be even greater than those seen in AD patients.7 This provided the rationale for evaluating cholinesterase inhibitors in both conditions in clinical trials.

Rivastigmine (Exelon®, Novartis) is a cholinesterase inhibitor that is widely available as a transdermal patch, oral solution and capsules. Currently, oral rivastigmine is approved by many regulatory authorities worldwide for the treatment of mild to moderate AD and PDD. In addition, in the past year the rivastigmine patch has been approved for the treatment of mild to moderate AD and mild to moderate PDD in a number of countries. These approvals were based on clinical trials in target populations, the results of which are reviewed here.

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