The effects of rivastigmine on neuropsychiatric symptoms in the early stages of Parkinson's disease : a systematic review
Reilly, Siobhan Dhaliwal, Simran Arshad, Usman Macerollo, Antonella Husain, Nusrat Da Costa, Antonio
Reilly, Siobhan
Dhaliwal, Simran
Arshad, Usman
Macerollo, Antonella
Husain, Nusrat
Da Costa, Antonio
Affiliation
Greater Manchester Mental Health NHS Foundation Trust; George Eliot Hospital NHS Trust, Nuneaton; Pakistan Institute of Living and Learning, Karachi, Pakistan; The University of Manchester; The Walton Centre NHS Foundation Trust, Liverpool; University of Liverpool; Mersey Care NHS Foundation Trust, Liverpool; Peninsula Health, Frankston South, Melbourne, Australia
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Publication date
2023-11-17
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Abstract
Background and purpose: Neuropsychiatric symptoms including depression, apathy and psychosis occur frequently in patients with Parkinson's disease. A subgroup of patients develop cognitive impairment, which may increase the risk of falls due to reduced attention. The acetylcholinesterase inhibitor rivastigmine is beneficial in Parkinson's disease dementia, but whether the use of rivastigmine is effective earlier in the disease course is unclear. The aim of this systematic review was to assess the evidence for rivastigmine in the treatment of neuropsychiatric symptoms in Parkinson's disease without dementia.
Methods: Embase, Medline, PsychINFO, Cochrane CENTRAL, NGLC, National Institute for Health and Care Excellence Evidence and medRxiv.org were searched for studies with terms relating to population (Parkinson's disease) and intervention (rivastigmine). Of 1922 references identified, 358 were duplications. Following title and abstract review, 1331 articles were excluded. After full-text review, nine articles remained.
Results: Outcomes were heterogenous, therefore, the results are presented in narrative form. The articles included six randomized controlled trials, two open-label trials and one case series. Outcome measures included: time to develop psychosis; frequency of rapid eye movement sleep behaviour disorder (RBD) episodes; apathy; gait variability; falls; cognitive ability; Neuropsychiatric Inventory score; and regional spontaneous brain activity.
Conclusions: There is evidence that rivastigmine is beneficial for RBD and apathy in Parkinson's disease patients without dementia. There is high level evidence that rivastigmine reduces falls, which may be due to improved attention. The impact of rivastigmine on psychotic symptoms is less clear, but is supported by current theoretical models which involve acetylcholine dysfunction in the generation of visual hallucinations in Parkinson's disease.
Keywords: Parkinson disease; acetylcholinesterase; hallucinations; neuropsychiatry; rivastigmine.
Citation
Reilly S, Dhaliwal S, Arshad U, Macerollo A, Husain N, Costa AD. The effects of rivastigmine on neuropsychiatric symptoms in the early stages of Parkinson's disease: A systematic review. Eur J Neurol. 2024 Feb;31(2):e16142. doi: 10.1111/ene.16142. Epub 2023 Nov 17.
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© 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.