The Acetylcholinesterase Inhibitors for Treatment of Cognitive and Behavioral Symptoms in Dementia With Lewy Bodies

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Journal of Neuropsychiatry (Impact Factor: 2.82). 02/2004; 16(4):409-25. DOI: 10.1176/appi.neuropsych.16.4.409
Source: PubMed


Dementia with Lewy bodies (DLB) is a common cause of dementia with effects on cognition, mood, behavior, and function. Changes in the acetylcholine system have been reported in brains of patients with DLB, which provides a rationale for trials of acetylcholinesterase inhibitors in DLB. This review includes all English-language publications found via Medline and related to the efficacy and/or safety of these compounds in DLB. Preliminary data suggest that these compounds may be efficacious in DLB and that future randomized clinical trials are strongly needed. Methodological limitations of the existing data include small sample sizes, and the paucity of standardized psychometric measures.

Download full-text


Available from: Martine Simard
  • Source
    • "This suggests that cognitive performance is closely dependent on the cholinergic system in PD-related cognitive impairment, whereas this relationship is weak in AD-related cognitive impairment. Furthermore, this finding in our study is supported by a previous clinical study indicating that the response to cholinesterase inhibitors is greater in DLB than in AD.27–29 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background and Purpose The substantia innominata (SI) contains the nucleus basalis of Meynert, which is the major source of cholinergic input to the cerebral cortex. We hypothesized that degeneration of the SI and its relationship to general cognitive performance differs in amyloidopathy and synucleinopathy. Methods We used magnetic resonance imaging (MRI)-based volumetric analysis to evaluate the SI volume in patients with amnestic mild cognitive impairment (aMCI), Alzheimer’s disease (AD), Parkinson’s disease-mild cognitive impairment (PD-MCI), PD with dementia (PDD), dementia with Lewy bodies (DLB), and healthy elderly controls. The correlation between SI volume and general cognitive performance, measured using the Korean version of the Mini-Mental State Examination (K-MMSE), was examined. Results Compared to control subjects, the mean normalized SI volume was significantly decreased in all of the other groups. The normalized SI volume did not differ between the subjects with PDD and DLB, whereas it was significantly smaller in subjects with PDD (p = 0.029) and DLB (p = 0.011) compared with AD. In subjects with PD-related cognitive impairment (PD-MCI, PDD, or DLB), there was a significant positive correlation between the SI volume and K-MMSE score (r = 0.366, p < 0.001), whereas no correlation was seen in subjects with AD-related cognitive impairment (aMCI or AD). Conclusions Our data suggest that the SI loss is greater in synucleinopathy-related dementia (PDD or DLB) than in AD and that the contribution of the SI to cognitive performance is greater in synucleinopathy than in amyloidopathy.
    Full-text · Article · Oct 2011
  • Source
    • "Demographical and clinical characteristics of these groups were shown in Table 1. Eight subjects were under medication “Exelon” (Simard and van Reekum, 2004). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Mosimann et al. (2005) reported prolongation of saccade latency of prosaccades in dementia with Lewy body (DLB). The goal of this study is to go further examining all parameters, such as rates of express latency, but also accuracy and velocity of saccades, and their variability. Methods: We examined horizontal and vertical saccades in 10 healthy elderly subjects and 10 patients with DLB. Two tasks were used: the gap (fixation target extinguishes prior to target onset) and the overlap (fixation stays on after target onset). Eye movements were recorded with the Eyelink II eye tracker. Results: The main findings were: (1) as for healthy, latencies were shorter in the gap than in the overlap task (a gap effect); (2) for both tasks latency of saccades was longer for DLB patients and for all directions; (3) express latency in the gap task was absent for large majority of DLB patients while such saccades occurred frequency for controls; (4) accuracy and peak velocity were lower in DLB patients; (5) variability of all parameters was abnormally high in DLB patients. Conclusions: Abnormalities of all parameters, latency, accuracy and peak velocity reflect spread deficits in cortical-subcortical circuits involved in the triggering and execution of saccades.
    Full-text · Article · Nov 2010 · Frontiers in Neurology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: I report here clinical effects of cholinesterase inhibitors (rivastigmine and donepezil) on visual hallucinations emerging in the course of Parkinson's disease (PD) and clinically unresponsive to antipsychotics. Five patients with PD (with or without dementia) complicated by visual hallucinations and unresponsive to atypical antipsychotics were offered a 12-week, open-label trial of a cholinesterase inhibitor. All 5 subjects completed the trial with no major adverse effects and, of note, no discontinuations due to adverse events. Visual hallucinations resolved in 4 subjects and were markedly diminished in one person. Neither changes in UPDRS scores nor exaggeration of subjective complaints about extrapyramidal symptoms were noted during treatment. Cholinesterase inhibitors might represent a useful alternative to antipsychotics for patients with PD accompanied by visual hallucinations even in the absence of dementia. One must, however, not forget that their use with this indication remains experimental and safety measures as well as accurate clinical surveillance are of crucial importance.
    Full-text · Article · Jan 2007 · Neurologia i neurochirurgia polska
Show more