Rivastigmine in Parkinson's Disease Dementia with Orthostatic Hypotension

Objective The purpose of this study was to evaluate if the cognitive benefit of rivastigmine is affected by the presence of orthostatic hypotension (OH) in patients with Parkinson's disease dementia (PDD). Methods We conducted a post hoc analysis on 1,047 patients with PDD from 2 randomized con...

Full description

Saved in:
Bibliographic Details
Published in:Annals of neurology 2021-01, Vol.89 (1), p.91-98
Main Authors: Espay, Alberto J., Marsili, Luca, Mahajan, Abhimanyu, Sturchio, Andrea, Pathan, Rashidkhan, Pilotto, Andrea, Elango, Damodaran S., Pezous, Nicole, Masellis, Mario, Gomez‐Mancilla, Baltazar
Format: Article
Language:English
Subjects:
Aged
Alzheimer Disease - drug therapy
Alzheimer's disease
Blood pressure
Cholinesterase Inhibitors - therapeutic use
Clinical trials
Cognition Disorders - drug therapy
Cognitive ability
Dementia
Dementia disorders
Female
Humans
Hypotension
Hypotension - drug therapy
Male
Middle Aged
Movement disorders
Neurodegenerative diseases
Neuroprotective Agents - therapeutic use
Neuropsychological Tests
Orthostatic hypotension
Parkinson Disease - drug therapy
Parkinson's disease
Rivastigmine
Rivastigmine - therapeutic use
Syncope
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Objective The purpose of this study was to evaluate if the cognitive benefit of rivastigmine is affected by the presence of orthostatic hypotension (OH) in patients with Parkinson's disease dementia (PDD). Methods We conducted a post hoc analysis on 1,047 patients with PDD from 2 randomized controlled trials comparing rivastigmine versus placebo at week 24 (n = 501) and rivastigmine patch versus capsule at week 76 (n = 546). A drop ≥ 20 mm Hg in systolic blood pressure (SBP) or ≥ 10 in diastolic blood pressure (DBP) upon standing classified subjects as OH positive (OH+); otherwise, OH negative (OH‐). The primary end point was the Alzheimer's Disease Assessment Scale ‐ Cognitive subscale (ADAS‐Cog) at week 24 and the Mattis Dementia Rating Scale (MDRS) at week 76, using intention‐to‐treat with retrieved dropout at week 24 and observed cases at week 76, consistent with the original analyses. Results Overall safety was comparable between OH+ (n = 288, 27.5%) and OH‐ (n = 730, 69.7%), except for higher frequency of syncope (9.2%) in the OH+ placebo arm. The placebo‐adjusted effect of rivastigmine on ADAS‐Cog at week 24 was 5.6 ± 1.2 for OH+ and 1.9 ± 0.9 in OH‐ (p = 0.0165). Among subjects with OH, the MDRS change from baseline at week 76 was higher for rivastigmine capsules versus patch (10.6 ± 2.9 vs ‐1.5 ± 3.0, p = 0.031). The overall prevalence of OH was lower for rivastigmine than placebo at week 24 (28.3% vs 44.6%, p = 0.0476). Interpretation The cognitive benefit from rivastigmine is larger in patients with PDD with OH, possibly mediated by a direct antihypotensive effect. ANN NEUROL 2021;89:91–98
ISSN:0364-5134
1531-8249
DOI:10.1002/ana.25923