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Rivastigmine for dementia in people with Down syndrome

The drug rivastigmine has been reported to have benefits for people with mild to moderate Alzheimer's disease who do not have Down syndrome. However, people with DS tend to present with AD at a much younger age than the general population as well as being physically different in terms of size, metabolism and heart rate, and may therefore have different requirements. This review identified no randomised controlled trials of rivastigmine in people with Down syndrome. Further research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Cholinesterase inhibitors (ChEIs), donepezil, galantamine and rivastigmine are efficacious for mild to moderate Alzheimer's disease

Alzheimer's disease is the commonest cause of dementia affecting older people, and is associated with loss of cholinergic neurons in parts of the brain. Cholinesterase inhibitors (ChEIs), donepezil, galantamine and rivastigmine, delay the breakdown of acetylcholine released into synaptic clefts and so enhance cholinergic neurotransmission.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Rivastigmine appears to moderately improve cognition and to a lesser extent activities of daily living in patients with PDD

Dementia is frequently associated with Parkinson's Disease. While a number of neurotransmitters appear to be involved, loss of cholinergic functioning is particularly associated with Parkinson's Disease Dementia (PDD) suggesting a potential utility for cholinesterase inhibitors. Rivastigmine appears to moderately improve cognition and to a lesser extent activities of daily living in patients with PDD. There was a clinically meaningful benefit in 15% of patients. Efficacy in other domains requires confirmation. Tolerability in particular nausea, vomiting and tremor appear problematic.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Rivastigmine for vascular cognitive impairment

Vascular dementia (i.e. dementia caused by disease of blood vessels affecting the supply of blood to the brain) is one of the most common types of dementia. It includes dementia caused by stroke. It may exist by itself or with other common dementias such as Alzheimer's disease. Sometimes vascular disease can present with cognitive problems which are less severe than dementia. Those with vascular dementia may have significant cognitive impairment without major memory loss. The term vascular cognitive impairment (VCI) is useful, because of the range of different ways in which people are affected. Rivastigmine is a drug widely used in Alzheimer's disease (AD). It works by preventing breakdown of acetylcholine, a neurotransmitter (signalling molecule). Levels of acetylcholine are reduced in VCI as well as in AD and so it may also help people with VCI. Researchers searched for all trials that compared rivastigmine with placebo in people with VCI, and identified three. Only one of these showed any significant results, and it did show some benefit for people with VCI who took rivastigmine. However, nausea and vomiting were a frequent side effect of taking the drug. Therefore it remains uncertain how useful rivastigmine is for people with VCI .

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Rivastigmine for people with Alzheimer's disease

We reviewed evidence comparing the effectiveness and safety of rivastigmine with placebo in people with Alzheimer's disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Comparing Alzheimer's Drugs

How do Alzheimer's drugs compare for treating symptoms?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: January 1, 2008

Alzheimer's disease: How effective are cholinesterase inhibitors?

Cholinesterase inhibitors can slightly delay the loss of mental abilities in people who have mild to moderate Alzheimer’s disease. But these medications may also cause nausea, vomiting or dizziness.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 18, 2013

Medications for the treatment of Alzheimer’s disease

There is currently no cure for Alzheimer’s disease. Various medications can somewhat delay the loss of mental abilities and independence. But they can also have side effects. It is not clear whether any of the medications are better than the others.Alzheimer’s disease is the most common cause of dementia. People who have dementia become forgetful and find it increasingly difficult to understand complex issues or express themselves in words. Their orientation in space and time gets worse and they need more and more support in everyday life. The speed at which the disease progresses varies greatly from person to person.In Alzheimer’s disease, more and more nerve cells in the brain die as time goes on. There is currently no way to cure the disease or stop its progression. But there are various medications which aim to maintain people’s memory and independence in everyday life for longer. Non-drug strategies include things like memory training or encouraging social activities.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: August 21, 2013

No convincing evidence from one trial of the efficacy of cholinesterase inhibitors for dementia with Lewy bodies

The characteristic features of dementia with Lewy bodies are dementia, marked fluctuation of cognitive ability, early and persistent visual hallucinations and spontaneous motor features of Parkinsonism. Other symptoms are repeated falls, syncope, transient disturbances of consciousness, neuroleptic sensitivity, and hallucinations in other modalities. This combination of features can be particularly difficult to manage, as antipsychotic drugs used to treat hallucinations, delusions and agitation will worsen Parkinsonian symptoms. The one included trial (of rivastigmine compared with placebo on 120 patients) showed no statistically significant difference between the two groups at 20 weeks. A possible beneficial effect on neuropsychiatric features was found only in analysis of observed cases, and may therefore be due to bias.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Pharmacological agents as symptomatic treatment for memory disorder in people with multiple sclerosis

This is an update of the Cochrane review "Pharmacologic treatment for memory disorder in multiple sclerosis" (first published in The Cochrane Library 2011, Issue 10).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

No convincing evidence from one trial of the efficacy of cholinesterase inhibitors for delirium

Delirium is a confusional state that is associated with physical illness. Its characteristic features are rapid onset, altered consciousness, reduced attention and global cognitive impairment. Other symptoms are hallucinations (particularly visual hallucinations), disturbed sleep pattern and agitation. Delirium is commonly found in hospital patients and is associated with longer admissions, poor functioning level, persistent cognitive impairment and need for institutional care. Delirium is therefore an important syndrome to recognise and treat. The one included trial, of donepezil compared with placebo in 15 patients, showed no statistically significant difference in length of delirium. No other outcomes were measured.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Cholinergic medication for neuroleptic‐induced tardive dyskinesia

Drug‐induced tardive dyskinesia is a common adverse effect of some antipsychotics, especially when these are given for an extended period of time. Tardive dyskinesia consists of involuntary repetitive movements, mainly in the oral region, but sometimes also in the limbs. It may become persistent. Cholinergic drugs, such as deanol, lecithin and meclofenoxate, have been used to treat tardive dyskinesia. This review did not identify any evidence to suggest that they are effective and found some to suggest that these old drugs may be toxic. New cholinergic drugs have been developed for the treatment of Alzheimer's disease, and it will be of interest to know if these drugs have an effect on the movements of tardive dyskinesia. We found one ongoing randomised trial.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Cholinesterase inhibitors are beneficial for people with Parkinson's disease and dementia

The clinical features of dementia with Lewy bodies (DLB) and Parkinson's disease with dementia (PDD) have much in common. As patients with DLB and PDD have particularly severe deficits in cortical levels of the neurotransmitter acetylcholine, blocking its breakdown using a group of chemicals known as cholinesterase inhibitors may lead to clinical improvement. Six trials showed a statistically significant improvement in global assessment, cognitive function, behavioural disturbance and activities of daily living rating scales in PDD and cognitive impairment in Parkinson's disease (CIND‐PD) patients treated with cholinesterase inhibitors. There was no current disaggregated evidence to support their use in CIND‐PD. In a single trial, no statistically significant improvement was observed in patients with DLB who were treated with cholinesterase inhibitors and further trials are necessary to clarify the effect of cholinesterase inhibitors in this patient group.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

[Cholinesterase inhibitors for rarer dementia associated with neurological conditions]

There are various rarer dementias including Huntington's disease (HD), cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), frontotemporal dementia (FTD), dementia in multiple sclerosis (MS) and progressive supranuclear palsy (PSP). A group of chemicals known as cholinesterase inhibitors are considered to be the first‐line medicines for Alzheimer's disease and some other dementias. Cholinesterase inhibitors may also lead to clinical improvement for rarer dementias associated with neurological conditions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

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