Cholinesterase Inhibitors for Parkinson's Disease: A Systematic Review
the MPR take:
Significant deficits in cholinergic transmission have been associated with cognitive decline and gait dysfunction in patients with Parkinson’s disease (PD). While the use of a cholinesterase inhibitors (ChI) in patients with PD may improve cognitive function and reduce the risk of falls, there is also a potential for worsening of motor features. A review in the Journal of Neurology, Neurosurgery & Psychiatry evaluated four clinical trials on the use of rivastigmine or donepezil in 941 patients with PD. Primary efficacy outcomes were cognition and rate of falls. ChIs were found to significantly slow cognitive decline but had no effect on risk of falls. Tremor rates and adverse drug reactions were also significantly higher in patients taking ChIs vs. control groups. The beneficial effects did not differ between rivastigmine and donepezil, but donepezil appeared to have a reduced risk of side effects vs. rivastigmine. However, this could be in part due to the small number of studies available for review. Physicians should carefully review the potential benefits and risks associated with ChIs for PD, taking into consideration the possibility of increased tremor and adverse drug reactions.
Background: Parkinson's disease (PD) is a progressive neurodegenerative movement disorder frequently associated with a wide variety of non-motor symptoms related to non-dopaminergic pathways. Therefore, use of a cholinesterase inhibitor (ChI) might improve cognitive function and reduce the risk of falls in patients with PD, although it could plausibly worsen motor features.
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