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Rivastigmine for Mild Cognitive Impairment in Parkinson’s Disease

Parkinson's disease studies at Penn

Scroll down for more information on this new Parkinson's study at the Perelman School of Medicine at the University of Pennsylvania.

Mild Cognitive Impairment in Parkinson’s Disease

Approximately 25% of Parkinson’s disease (PD) patients experience Mild Cognitive Impairment (MCI). MCI, including difficulty with problem solving, planning, attention, or recalling information, can be a significant problem. Even mild cognitive difficulties can lead to worse functioning, decreased quality of life, and depression for patients with PD, as well as difficulty for their caregivers. Thus, treatment at this early stage would improve both cognitive symptoms and some of the other problems associated with these symptoms. 

Despite the fact that MCI is a serious problem for Parkinson’s disease patients, little is known about how best to treat it. There are only three published studies to date of medication trials to enhance cognition in PD patients with MCI. One placebo-controlled study tested the effect of galantamine (a cholinesterase inhibitor (ChEI) but found no benefit on cognition. Another study tested the effect of donepezil (another ChEI) on executive dysfunction in PD, and participants demonstrated some improvement on cognitive tests. Finally, in a small open-label study in self-reported executive dysfunction in PD, atomoxetine (a selective norepinephrine reuptake inhibitor) was associated with some improvement on cognitive testing.

In some cases, PD-MCI can eventually develop into Parkinson’s Disease Dementia (PDD). Rivastigmine (also a ChEI) is an effective, FDA approved treatment for PDD. It is thought to work by inhibiting acetylcholinesterase, an enzyme that metabolizes acetylcholine in the brain. Acetylcholine is the neurotransmitter most closely associated with cognitive abilities, and is affected to a significant degree in PD. Thus, it is thought that this medication increases acetycholine levels in the brain, and this improves cognition.

Penn Research Study: Rivastigmine for Mild Cognitive Impairment in Parkinson’s Disease

Although Rivastigmine is used as a treatment for cognitive issues arising in PDD, it is unknown if this medication would be useful in the treatment of PD-MCI. Fortunately, the University of Pennsylvania has developed a study to test this very issue. This study is a 24-week long clinical trial to see if the Exelon Patch (rivastigmine), is useful in treating MCI in patients with PD. This study is broken down into 2 phases, each lasting 10 weeks. In one phase, participants will receive the Exelon Patch, and in the other phase, participants will receive a placebo patch (no medication). While patients are guaranteed to be on the active medication during one of the phases, the study is blinded so no one will know when they are on the active or placebo patch. There is also a 4-week break between the two phases. Participants will be evaluated in-person 6 times during this study.

This study is being conducted by the University Of Pennsylvania School Of Medicine with Daniel Weintraub, MD, as the Principal Investigator, and Matthew Stern, as the Co-Principal Investigator. We will be recruiting participants throughout 2012 and 2013. Participation in this study is voluntary.

For More Information

For more information on this clinical trial, please call one of the following contacts:

Studies in Aging and Age Related Diseases @ Penn

Studies and clinical trials are ongoing in many areas of aging and age related diseases. It requires an investment of your time and travel to Penn, but the reward is knowing that you made a direct contribution to advancing what researchers and clinicians know about a particular disease or disorder.

Click here to learn more about other studies in aging and age related diseases at Penn that are open and recruiting participants.