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Rivastigmine in the treatment of patients with Alzheimer's disease

Muller T ...see all

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

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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. 2007 Dove Medical Press Limited. All rights reserved

Author-supplied keywords

  • *Alzheimer disease/dt [Drug Therapy]
  • *rivastigmine/ae [Adverse Drug Reaction]
  • *rivastigmine/cb [Drug Combination]
  • *rivastigmine/cm [Drug Comparison]
  • *rivastigmine/ct [Clinical Trial]
  • *rivastigmine/do [Drug Dose]
  • *rivastigmine/dt [Drug Therapy]
  • *rivastigmine/pd [Pharmacology]
  • *rivastigmine/pk [Pharmacokinetics]
  • *rivastigmine/td [Transdermal Drug Administration]
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  • 120014-06-4 (donepezil)
  • 142057-77-0 (donepezil)
  • 51-61-6 (dopamine)
  • 51-84-3 (acetylcholine)
  • 5786-21-0 (clozapine)
  • 60-31-1 (acetylcholine)
  • 66-23-9 (acetylcholine)
  • 9000-81-1 (acetylcholinesterase)
  • 9001-08-5 (cholinesterase)
  • Embase
  • Germany
  • New Zealand
  • Parkinson disease/dt [Drug Therapy]
  • acetylcholine/ec [Endogenous Compound]
  • acetylcholinesterase/ec [Endogenous Compound]
  • anorexia/si [Side Effect]
  • article
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  • attention
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  • cholinergic receptor blocking
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  • drug degradation
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  • drug dosage form comparison
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  • drug dose escalation
  • drug dose titration
  • drug efficacy
  • drug fever/si [Side Effect]
  • drug megadose
  • drug metabolism
  • drug potency
  • drug protein binding
  • drug safety
  • drug tolerability
  • drug withdrawal
  • dyspepsia/si [Side Effect]
  • enzyme
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  • extrapyramidal syndrome/si [Side Effect]
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  • galantamine/pd [Pharmacology]
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  • nausea/si [Side Effect]
  • nerve degeneration
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  • neuroleptic agent/dt [Drug Therapy]
  • neurology
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  • quetiapine/cm [Drug Comparison]
  • quetiapine/dt [Drug Therapy]
  • quetiapine/pd [Pharmacology]
  • recommended drug dose
  • side effect/si [Side Effect]
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  • symptom
  • transdermal patch
  • treatment outcome
  • university
  • unspecified side effect/si [Side Effect]
  • vomiting/si [Side Effect]
  • weight reduction

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  • T Muller

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