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The Effects of Rivastigmine on Neuropsychiatric Symptoms in the Early Stages of Parkinson's Disease: A Systematic Review

Published online by Cambridge University Press:  07 July 2023

Siobhan Reilly ,
Simran Dhaliwal ,
Usman Arshad ,
Nusrat Husain ,
Antonella Macerollo  and
Antonio Da Costa
Siobhan Reilly*
Affiliation:
Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
Simran Dhaliwal
Affiliation:
George Eliot Hospital NHS Trust, Nuneaton, United Kingdom
Usman Arshad
Affiliation:
Pakistan Institute of Living and Learning, Lahore, Pakistan
Nusrat Husain
Affiliation:
University of Manchester, Manchester, United Kingdom
Antonella Macerollo
Affiliation:
The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
Antonio Da Costa
Affiliation:
Frankston Hospital, Melbourne, Australia
*
*Corresponding author.
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Abstract

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Aims

Neuropsychiatric symptoms including depression, apathy and psychosis are experienced by the majority of patients with Parkinson's disease. A subgroup of patients develop cognitive impairment, which may increase the risk of falls due to reduced attention. Acetylcholine deficit is thought to contribute to neuropsychiatric symptoms in Parkinson's disease. The acetylcholinesterase inhibitor rivastigmine is beneficial in Parkinson's disease dementia (PDD), but the consensus for the use of rivastigmine earlier in the disease course is unclear. This systematic review aims 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, NICE Evidence and medRxiv.org were searched for studies with terms relating to Population (Parkinson's disease) and intervention (rivastigmine).

1922 references were identified, of which 358 were duplications.

Inclusion criteria were: diagnosis of Parkinson's disease, rivastigmine intervention and the presence of neuropsychiatric symptoms or falls. Articles were excluded if they only related to patients with dementia.

Following title and abstract review, 1331 articles were excluded.

After full text review, 9 articles remained, which underwent a risk of bias analysis.

Results

Outcomes were heterogenous, so were not suitable for meta-analysis. Therefore, the results are presented in narrative form. The articles included 6 Randomised Controlled Trials (RCTs), 2 open-label trials and 1 case-series.

Three of the studies focused on psychosis. Two of these studies indicated a benefit of rivastigmine on psychotic symptoms in Parkinson's disease. However, these studies were an open label trial and a case series, and the results were not reproduced during RCT.

One RCT indicated benefit of rivastigmine in rapid eye movement behaviour disorder (RBD).

One RCT showed improvements in apathy after treatment with rivastigmine.

Two RCTs demonstrated a reduction in falls with rivastigmine treatment compared to placebo.

One RCT showed a significant improvement on a performance-based measure of cognitive ability.

One study identified brain areas that were hypoactive in hallucinating Parkinson's patients, and the reduced activity could be restored with rivastigmine. This restoration of activity was associated with improved attention compared to baseline.

Conclusion

There is evidence that rivastigmine is beneficial for RBD and apathy in Parkinson's disease, independently from the presence of 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.

Type
Psychopharmacology
Information
BJPsych Open , Volume 9 , Supplement S1: Abstracts from the RCPsych International Congress 2023, 10–13 July , July 2023 , pp. S192
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NC
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. This does not need to be placed under each abstract, just each page is fine.
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists

Footnotes

Abstracts were reviewed by the RCPsych Academic Faculty rather than by the standard BJPsych Open peer review process and should not be quoted as peer-reviewed by BJPsych Open in any subsequent publication.

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