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BACKGROUND AND OBJECTIVEAmong the non-motor features of Parkinson's disease (PD), cognitive impairment has been shown to have a high, negative impact on the patient's quality of life. Postmortem studi
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BACKGROUND AND OBJECTIVEAmong the non-motor features of Parkinson's disease (PD), cognitive impairment has been shown to have a high, negative impact on the patient's quality of life. Postmortem studies of patients with PD have shown degeneration of cholinergic and nigrostriatal pathways. This systematic review was undertaken to clarify the efficacy of cholinesterase inhibitors (ChIs) for symptoms of PD.
METHODSFour databases were searched with 945 articles identified by the initial search. From these, four randomized, controlled trials, were included in the meta-analysis. Among those were one comparing rivastagmine with placebo, and three comparing donepezil with placebo. The primary outcome measure was cognitive function, assessed using the Mini Mental State Examination, and rate of falls. Safety measures and secondary outcomes were also included.
RESULTSThe meta-analysis revealed that ChIs significantly slowed MMSE decline (P＝0.001), without improving the risk of falls (P＝0.681). Alzheimer's Disease Assessment-cognitive subscale, global assessment and behavioral disturbance improved in the ChIs group (P<0.001, P<0.001 and P＝0.025, respectively), without impacting disability (P＝0.053). Death rate was significantly decreased in the ChIs group (odds ratio 0.295; P＝0.01). Increased tremor rates and adverse reactions were noted in the ChIs group (P＝0.001 and P<0.0001, respectively).
CONCLUSIONThis meta-analysis of patients with Parkinson's disease, treated with cholinesterase inhibitors, found that these medications can treat cognitive impairment but do not significantly improve gait dysfunction and fall risk.
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