Donepezil in the treatment of hallucinations and delusions in Parkinson's disease.
ABSTRACT As cholinergic mechanisms may be at least partially responsible for hallucinations and delusions in Parkinson's disease (PD), we conducted an open study in 8 PD patients to assess the efficacy and tolerability of the cholinesterase inhibitor donepezil, 5 mg at bedtime for two months, in the treatment of these complications. Hallucinations and delusions improved significantly in all patients. Donezepil was overall well tolerated, but a deterioration in motor disability was noted in 2 out of 8 patients.
Article: Efficacy and safety of galantamine (reminyl) for dementia in patients with Parkinson's disease (an open controlled trial)[show abstract] [hide abstract]
ABSTRACT: An open controlled trial of the use of galantamine at a maximum dose of 16 mg/day included 41 patients with Parkinson's disease with dementia randomized to a galantamine treatment group (21 patients) and a control group (20 patients). Cognitive, neuropsychiatric, and motor symptoms were assessed clinically before the trial and at 4, 12, and 24 weeks, using the Mini Mental State Examination (MMSE), the cognitive Alzheimer's Disease Assessment Scale (ADAS-cog), the clock drawing test, the Frontal Assessment Battery (FAB), and the Neuropsychiatric Inventory (NPI) with assessment of distress in relatives. Patients treated with galantamine had better scores on the MMSE (p < 0.05),ADAS-cog (p < 0.05), the clock drawing test (p < 0.05), and the FAB (p < 0.01) at the end of the study period as compared with the control group. Changes in total point scores on the NPI-12 at the ends of weeks 12 and 24, as compared with the beginning of the trial, were in favor of the group treated with galantamine, with significant changes in the hallucinations (p = 0.0002), anxiety (p = 0.04), sleep disturbance (p = 0.04), and apathy (p = 0.006) sections. Galantamine treatment was accompanied by decreases in the level of distress in patients' relatives (p = 0.007) and improvements in daily activity (p = 0.003). Improvements in gait and decreases in freezing and falls were seen in the galantamine treatment group. However, two patients of this group showed minor increases in tremor. Side effects (drooling, postural hypotension, nausea, dysuria) occurred in seven patients (30%).Neuroscience and Behavioral Physiology 04/2012; 38(9):937-945.
Article: Cross-cultural evaluation of the modified Parkinson Psychosis Rating Scale across disease stages.[show abstract] [hide abstract]
ABSTRACT: This study assessed the psychometric attributes of the modified Parkinson Psychosis Rating Scale (mPPRS). In an attempt to improve scale's scaling assumptions and content validity, all types of hallucinations were rated and all items were scored based on intensity. The scale was cross-culturally adapted to four Latin American countries (Argentina, Brazil, Ecuador, and Paraguay). Acceptability, internal consistency, factor structure, convergent and known-groups validity, and precision (standard error of measurement, SEM) were explored. A total of 388 patients with PD were included in the study (age, 64.5 +/- 10.7 years; 59.8% males; PD duration, 8.2 +/- 4.9 years). The mPPRS was highly usable in terms of missing values generated and scores distribution (total computable scores, 99.7%, ceiling effect, <15%). Scaling assumptions were acceptable as noted by the range of item-total correlations (0.14-0.55, only one coefficient below 0.2). Internal consistency was adequate for research use (Cronbach alpha, 0.7). Factor analysis identified two factors that accounted for 58.5% of the variance. Low correlation coefficients were found with cognitive function (SCOPA-Cog) and disease severity (CISI-PD) (r(S) <or= 0.30), whereas correlation with psychosis were high (r(S) = 0.56). Known-groups validity analyses indicated a significant increase in mPPRS scores by Hoehn and Yahr stage (P < 0.001). The SEM value was 1.06. Overall, the results suggest that the mPPRS is a useful tool for evaluation of psychosis in PD. The results show that some psychometric properties of the mPPRS are satisfactory albeit there is room for the improvement of scale's content validity and internal consistency. (c) 2010 Movement Disorder Society.Movement Disorders 03/2010; 25(10):1391-8. · 4.51 Impact Factor
Article: Use of Memantine (akatinol) for the Correction of Cognitive Impairments in Parkinson’s Disease Complicated by Dementia[show abstract] [hide abstract]
ABSTRACT: This study addresses the effects of 52 weeks of treatment with the NMDA glutamate receptor antagonist memantine on motor, cognitive, and mental disorders in patients with Parkinson’s disease complicated by dementia, as compared with a control group of patients not treated with memantine. Patients of the experimental group (32 subjects) received memantine (20 mg/day), while patients in the control group continued on antiparkinsonism treatment alone. Cognitive, psychiatric, and motor symptoms were assessed before the study and then at the ends of weeks 12, 24, and 52, using clinical assessment, rating scales, and neuropsychological tests. Plasma homocysteine levels were measured by HPLC. Patients treated with memantine had better measures on the MMSE (p < 0.05), ADAS-cog (p < 0.05), clock drawing test (p < 0.05), and FAB (p < 0.01) as compared with the control group by the end of study week 24. Members of the group of patients with high homocysteine levels mounted significantly better responses with memantine treatment, as compared with patients of the control group with high homocysteine levels but not receiving memantine, at the ends of study weeks 24 and 52, in terms of all rating scales (UPDRS, MMSE, ADAS-cog, D-KEFS Verbal Fluency Test, FAB. NPI, and DAD, p < 0.05). By the end of week 52, significant changes in points scores on the NPI-12 scale from baseline were in favor of patients receiving memantine, this applying to the disinhibition (p = 0.006), irritability (p = 0.04), anxiety (p = 0.04), and hallucinations (p = 0.048) subscales. The presence of hyperhomocysteinemia may indicate faster progression of both motor and cognitive impairments in Parkinson’s disease. Prolonged memantine treatment of patients with Parkinson’s disease complicated by dementia leads to improvements in cognitive functions, stabilization of motor impairments, and decreases in the severity of mental disorders, especially in patients with hyperhomocysteinemia.Neuroscience and Behavioral Physiology 04/2012; 40(2):149-155.