Clinical Medicine Reviews in Therapeutics

Background: Rivastigmine is licensed for the treatment of Parkinson’s disease dementia (PDD). The aim of the current article is to review the evidence regarding rivastigmine for the treatment of PDD. Three open label studies and one Randomized Controlled Trial (RCT) have been undertaken examining the efficacy of rivastigmine in PDD. In the 24 week RCT, 362 patients were randomised to rivastigmine, and 179 patients to placebo. Significant improvements were seen in cognition, function and global outcome. Nausea affected 29% of patients in the rivastigmine group and 11% of patients in the placebo group, and vomiting was reported by 17% of patients given rivastigmine and 2% of patients given placebo. Emerging or worsening tremor was reported in 10% of patients in the rivastigmine group, compared with 4% in the placebo group.

Conclusion: Rivastigmine is a safe and effective symptomatic treatment for PDD conferring benefits with respect to cognition, function and overall clinical outcome. Further work is needed to establish the comparable efficacy to other cholinesterase inhibitors, the impact on core disease pathology and the potential additive benefits of combination with memantine.