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Journal article

Rivastigmine in the treatment of patients with Alzheimer's disease

T. M...(+1 more)

Neuropsychiatric Disease and Treatment, vol. 3, issue 2 (2007) pp. 211-218

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Abstract

Impairment of attention and memory in patients with Alzheimer's disease (AD) is associated with significantly lower levels of acetylcholine. Inhibition of the breakdown of acetylcholine by blocking the enzymes acetylcholinesterase and butyrylcholinesterase with rivastigmine improves this cholinergic depletion. Thus rivastigmine administration provides established, effective, long-term symptomatic treatment in AD and Parkinson's disease (PD) patients with dementia. A sustained treatment with cholinesterase inhibitors in general may also induce a certain deterioration of fine motor behavior, which may play a crucial role in the treatment of PD patients with dementia. Recent studies show that this altered balance between dopamine and acetylcholine due to cholinesterase inhibition, with its possible negative impact on motion behaviour, does not present a major problem in clinical practice in AD patients and may be compensated for by modification of dopaminergic substitution in PD patients with dementia. However, progression of neurodegeneration increases the vulnerability for psychosis in AD and PD patients with dementia in combination with dehydration and often requires additional application of neuroleptics. Since classical neuroleptics increase extrapyramidal symptoms, atypical neuroleptics are used. Out of these, quetiapine shows a distinct lower anticholinergic (muscarinergic) potency with beneficial effects on cognition. This favors its use in combination with rivastigmine. (copyright) 2007 Dove Medical Press Limited. All rights reserved.

Author-supplied keywords

  • Alzheimer disease
  • Parkinson disease
  • acetylcholine
  • acetylcholinesterase
  • anorexia
  • article
  • asthenia
  • cholinergic receptor blocking
  • cholinesterase
  • cholinesterase inhibition
  • cholinesterase inhibitor
  • clinical trial
  • clozapine
  • cognitive defect
  • donepezil
  • dopamine
  • dose response
  • drug capsule
  • drug degradation
  • drug delivery system
  • drug dosage form comparison
  • drug dose comparison
  • drug dose escalation
  • drug dose titration
  • drug efficacy
  • drug fever
  • drug megadose
  • drug metabolism
  • drug potency
  • drug protein binding
  • drug safety
  • drug tolerability
  • drug withdrawal
  • dyspepsia
  • exelon
  • extrapyramidal syndrome
  • galantamine
  • human
  • leukopenia
  • long term care
  • low drug dose
  • motor dysfunction
  • nausea
  • nerve degeneration
  • neuroleptic agent
  • nonhuman
  • placebo
  • quality of life
  • quetiapine
  • recommended drug dose
  • rivastigmine
  • side effect
  • skin redness
  • transdermal patch
  • treatment outcome
  • unspecified side effect
  • vomiting
  • weight reduction

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