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Rivastigmine Improves Executive Functioning in Parkinson's Disease Dementia: Presented at ANA

By Charlene Laino

BALTIMORE, Md -- October 18, 2009 -- Patients diagnosed with Parkinson's disease dementia demonstrated better executive function when treated with rivastigmine than when administered placebo, according to a study presented here at the American Neurological Association (ANA) 134th Annual Meeting.

Relative to placebo, patients demonstrated significant improvements on the Delis-Kaplan Executive Function System subtests and the Symbol Digit Modalities Test, explained investigator Frederick A. Schmitt, PhD, Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, speaking here at a poster presentation on October 14.

"These findings suggest meaningful effects on executive functions such as the flexibility of thinking, inhibition, problem solving, planning, impulse control, concept formation, abstract thinking, processing speed, and creativity in both verbal and spatial modalities," Dr. Schmitt enumerated.

After 24 weeks of therapy with rivastigmine, the average number of correct responses on the tests administered increased by 2 among the 258 patients assigned to receive rivastigmine compared with a decline of 1 correct answer among the 144 patients on placebo (P < .001).

"In particular, rivastigmine-treated patients showed significant improvements on 3 of 4 outcome measures of the Delis-Kaplan Executive Function System Letter Fluency Test -- suggesting [rivastigmine] may benefit processing speed and the ability to retrieve responses," said Dr. Schmitt.

The ad hoc analysis of the tests is limited by the fact that the instruments were not administered to all patients at all the sites in the study.

The patients in the study were all at least 50 years of age, and had been diagnosed with Parkinson's disease dementia for at least 2 years. Patients were randomly assigned in a 2:1 ratio to either 3 to 12 mg/day of rivastigmine or placebo. In the primary outcome of the trial, treatment with rivastigmine was found to improve scores by 2.9 points on the Alzheimer's Disease Assessment Scale-Cognitive Subscale (P < .001) and by 0.5 points on the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change scale (P = .007).

In reviewing the secondary outcome measures, Dr. Schmitt said, "Overall, rivastigmine treatment may improve executive function in patients with Parkinson's disease dementia as compared with placebo."

Funding for this study and for the secondary analysis was provided by Novartis Pharmaceuticals.

[Presentation title: EFFECTS of Rivastigmine on Measure of Executive Function: Results From a 24-Week Placebo-Controlled Clinical Trial in Patients With Parkinson's Disease Dementia. Abstract T-66]

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