Movement Disorders Program, Department of Neurology, Medical College of Georgia, Augusta, GA, USA.
Neuropsychiatr Dis Treat. 2007 Dec;3(6):775-83. doi: 10.2147/ndt.s1134.
Parkinson's disease (PD) afflicts millions of people worldwide and leads to cognitive impairment or dementia in the majority of patients over time. Parkinson's disease dementia (PDD) is characterized by deficits in attention, executive and visuospatial function, and memory. The clinical diagnostic criteria and neuropathology surrounding PDD remain controversial with evidence of overlap among PDD, dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). Cortical cholinergic deficits are greater in PDD than in AD, and are well-correlated with the cognitive and neuropsychiatric dysfunction that occurs in PDD. Inhibition of acetylcholine metabolism is therefore a practical therapeutic strategy in PDD.This review examines current evidence for rivastigmine (a cholinesterase/butyrylcholinesterase inhibitor) treatment in PDD. In addition to its efficacy, we examine the safety profile, side effects, and cost effectiveness of rivastigmine in PDD. Rivastigmine provides modest benefit in PDD and further long-term studies are needed to determine the effectiveness and safety of rivastigmine over time. Tolerability is a problem for many PDD patients treated with rivastigmine. Future studies of rivastigmine in PDD should focus on pragmatic outcomes such as time to need for nursing home placement, pharmacoeconomic outcomes and simultaneous patient/caregiver quality of life assessments.
帕金森病（PD）影响着全球数以百万计的人，并导致大多数患者随着时间的推移认知能力下降或出现痴呆。帕金森病痴呆（PDD）的特点是注意力、执行和视空间功能以及记忆缺陷。PDD 的临床诊断标准和神经病理学仍然存在争议，其与路易体痴呆（DLB）和阿尔茨海默病（AD）之间存在重叠证据。与 AD 相比，PDD 中的皮质胆碱能缺陷更大，并且与 PDD 中发生的认知和神经精神功能障碍密切相关。因此，抑制乙酰胆碱代谢是 PDD 的一种实用治疗策略。
这篇综述检查了目前在 PDD 中使用rivastigmine（一种乙酰胆碱酯酶/丁酰胆碱酯酶抑制剂）治疗的证据。除了其疗效外，我们还检查了rivastigmine 在 PDD 中的安全性概况、副作用和成本效益。rivastigmine 在 PDD 中提供了适度的益处，需要进一步的长期研究来确定其在一段时间内的有效性和安全性。许多接受 rivastigmine 治疗的 PDD 患者耐受性差。未来关于 PDD 中 rivastigmine 的研究应侧重于实用结果，如需要入住养老院的时间、药物经济学结果以及同时对患者/护理人员的生活质量进行评估。
