Objective: Outcome of Rivastigmine treatment in Parkinson’s disease Dementia (PDD). Effect of treatment on cognition and Neuropsychiatric symptoms. To compare clinical global impression of Clinicians and carers.

Background: PDD (onset of Cognitive impairment after one year of Diagnosis of PD) is a major factor deciding quality of life, disability, care home placement and increase care burden. Only drug licensed in UK is Rivastigmine.

Methods: Movement disorder clinic in a acute Hospital managing over 600 patients with Parkinson’s disease under care of one clinician (SR), have a web based database capturing all management, treatment and outcome for last 15 years. Diagnosis of PDD was based on symptoms, day to day cognitive problems, MOCA / MMSE / ACE-R scores Following drug reviews.We analysed all patients treated with Rivastigmine over last 10 years.

Results: 43 patients had complete follow up for at least 5 years from Diagnosis of PD. Mean age of patients at diagnosis of PD was 68 and PDD was 74. H&Y at diagnosis of PD (mean 2.04), PDD (mean 3.42), Mean MMSE at diagnosis of PDD 25, MOCA 20 and ACE-R 74. 65% patients had Excessive daytime sleepiness (EDS), 75% had VH. Diagnosis to start of Rivastigmine therapy was 7.3 months and mean duration of treatment with Rivastigmine was 33.7 months. Daily mean dose of Rivastigmine was 7.45 mg. On treatment EDS improved to be only in 19% (from 65%) and VH in only 28% (from 75%), most improvement was noted in females (VH 44% to 15%, EDS 39% to 9%. Paranoia improved 19% to 7%. There was no noticeable improvement in cognitive scores. Use of Quetiapine decreased from 46% to 28%. CGI showed 26% better (Carers 7%), 35% same (carer 37%) and 40% worse (carer 56%). 67% of patients stayed at home at the last follow up (53% alive), while 33% in care home (19% alive). 32% patients went into care Home and 42% of those died, 67% remained at home and 21% of those died.

Conclusions: Rivastigmine in an unselected PDD group showed significant improvement in VH and EDS without improving cognition. It also significantly reduced need for Quetiapine use. In our cohort greatest improvement in Neuropsychiatric symptoms (VH/ EDS) were in females. Most effective dose in this study was 6-9mg daily. Clinicians Global impression (CGI) for better didnt match with Carer Global impression (CGI-C). Rivastigmine in PDD will only improve VH and EDS and reduce need for antipsychotics use rather than cognition.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-rivastigmine-in-parkinsons-disease-dementia-a-logitudinal-observational-study/