Effects of Cholinesterase Inhibitors in Parkinson's Disease Dementia: A Review of Clinical Data

Teus Van Laar, Peter Paul De Deyn, Dag Aarsland, Paolo Barone, James E. Galvin

Research output: Contribution to journalReview articlepeer-review

46 Scopus citations


Aims: Cognitive impairment and dementia are common features of Parkinson's disease (PD). Patients with Parkinson's disease dementia (PDD) often have significant cholinergic defects, which may be treated with cholinesterase inhibitors (ChEIs). The objective of this review was to consider available efficacy, tolerability, and safety data from studies of ChEIs in PDD. Discussions: A literature search resulted in the identification of 20 relevant publications. Of these, the treatment of PD patients with rivastigmine, donepezil, or galantamine was the focus of six, eleven, and two studies respectively, while one study reported use of both tacrine and donepezil. The majority of studies were small (<40 patients), with the exception of two large randomized controlled trials (RCTs) that are the main focus of this review. In the smaller studies, treatment benefits were reported on a range of outcome measures, though results were extremely variable. While the full results of a large RCT of donepezil in patients with PDD are not yet available, significant treatment differences were reported on the CIBIC-plus at the highest treatment dose. A trend toward improvement was also observed in treated patients on the ADAS-cog. The second large RCT found significant improvements in rivastigmine-treated patients compared with placebo on both the ADAS-cog (P < 0.001) and the ADCS-CGIC (P < 0.007), as well as on all secondary efficacy outcomes. Consequently, rivastigmine is now widely approved for the symptomatic treatment of mild to moderate PDD. Conclusions: Taken together, these studies suggest that ChEIs are efficacious in the treatment of PDD.

Original languageEnglish (US)
Pages (from-to)428-441
Number of pages14
JournalCNS Neuroscience and Therapeutics
Issue number5
StatePublished - Oct 2011
Externally publishedYes


  • Cholinesterase inhibitors
  • Donepezil
  • Parkinson's disease dementia
  • Review
  • Rivastigmine

ASJC Scopus subject areas

  • Pharmacology
  • Psychiatry and Mental health
  • Physiology (medical)
  • Pharmacology (medical)


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