Is Cognitive Benefit of Rivastigmine Tied to Orthostasis in Parkinson Disease Dementia?

The cognitive benefits provided by rivastigmine are more pronounced in Parkinson disease dementia when orthostatic hypotension is present.

These authors evaluated an important clinical question: Whether the cognitive benefit provided by the cholinesterase inhibitor rivastigmine could be affected by the presence of orthostatic hypotension (OH) in the setting of Parkinson disease dementia. The manufacturer-sponsored post hoc analysis included 1047 patients drawn from two randomized, controlled trials that compared cognitive effects of rivastigmine and placebo at 6 months (n=501) and compared a rivastigmine patch with a capsule at 76 weeks (n=546). OH was defined as a drop of ≥20 mm Hg in systolic blood pressure (SBP) or ≥10 mm Hg in diastolic blood pressure (DBP) upon standing. The primary outcome was the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog) at 6 mo…

Reviewing Author

Michael S. Okun, MD

Disclosures

Consultant/Advisory BoardParkinson’s Foundation; Tourette Association of America

Speaker’s BureauMedscape/WebMD CME, Movement Disorders Society CME, American Academy of Neurology CME

RoyaltiesBooks4Patients; Demos; Cambridge; Taylor and Francis; Robert Rose; Public Affairs

Grant/Research SupportNational Institutes of Health; Parkinson’s Foundation; Tourette Association of America; University of Florida Foundation

Editorial BoardsTremor and Other Hyperkinetic Movements; JAMA Neurology

Leadership Positions in Professional SocietiesParkinson’s Foundation (Medical Advisor)