BACKGROUND AND OBJECTIVE:Rivastigmine is approved in the USA for the treatment of mild to moderate Alzheimer's disease and Parkinson's disease dementia (PDD). Executive function (EF) deficits are a core symptom of PDD. The current objective was to investigate the effects of rivastigmine capsules versus placebo on EF in PDD, focusing on secondary outcome measures from a large, international, randomized, double-blind, placebo-controlled, 24-week trial (EXPRESS, CENA713B2311). METHODS: Secondary outcomes included Delis-Kaplan Executive Function System (D-KEFS) measures of EF. Data from three D-KEFS subtests (Card Sorting, Letter Fluency, Color-Word Interference), plus the Symbol Digit Modalities Test were analyzed in the observed case (OC) population. Changes from baseline in the rivastigmine versus placebo groups were evaluated using the van Elteren test blocking for country. RESULTS: Of 541 patients in the EXPRESS study, 402, 71, 97, and 65 patients provideddata for Letter Fluency, Card Sorting and Color-Word Interference subtests, and the Symbol Digit Modalities Test, respectively. On Letter Fluency, rivastigmine was associated with improvements in correct responses, set loss errors, and responses made (all P < 0.05), but not repetition errors. Higher Card Sorting recognition description score (P= 0.03), and more correct substitutions on the Symbol Digit Modalities Test (P= 0.02) were also recorded. CONCLUSION:Rivastigmine was associated with significant improvements over placebo on EF tests evaluating flexibility of thinking, problem solving and planning in patients with PDD. These findings support the hypothesis that rivastigmine may affect frontal subcortical circuits, which potentially contributes to observed clinical improvement associated with EF.
RCT Entities:
BACKGROUND AND OBJECTIVE:Rivastigmine is approved in the USA for the treatment of mild to moderate Alzheimer's disease and Parkinson's disease dementia (PDD). Executive function (EF) deficits are a core symptom of PDD. The current objective was to investigate the effects of rivastigmine capsules versus placebo on EF in PDD, focusing on secondary outcome measures from a large, international, randomized, double-blind, placebo-controlled, 24-week trial (EXPRESS, CENA713B2311). METHODS: Secondary outcomes included Delis-Kaplan Executive Function System (D-KEFS) measures of EF. Data from three D-KEFS subtests (Card Sorting, Letter Fluency, Color-Word Interference), plus the Symbol Digit Modalities Test were analyzed in the observed case (OC) population. Changes from baseline in the rivastigmine versus placebo groups were evaluated using the van Elteren test blocking for country. RESULTS: Of 541 patients in the EXPRESS study, 402, 71, 97, and 65 patients provided data for Letter Fluency, Card Sorting and Color-Word Interference subtests, and the Symbol Digit Modalities Test, respectively. On Letter Fluency, rivastigmine was associated with improvements in correct responses, set loss errors, and responses made (all P < 0.05), but not repetition errors. Higher Card Sorting recognition description score (P= 0.03), and more correct substitutions on the Symbol Digit Modalities Test (P= 0.02) were also recorded. CONCLUSION:Rivastigmine was associated with significant improvements over placebo on EF tests evaluating flexibility of thinking, problem solving and planning in patients with PDD. These findings support the hypothesis that rivastigmine may affect frontal subcortical circuits, which potentially contributes to observed clinical improvement associated with EF.
Authors: Donald R Royall; Edward C Lauterbach; Jeffrey L Cummings; Allison Reeve; Teresa A Rummans; Daniel I Kaufer; W Curt LaFrance; C Edward Coffey Journal: J Neuropsychiatry Clin Neurosci Date: 2002 Impact factor: 2.198
Authors: Murat Emre; Dag Aarsland; Alberto Albanese; E Jane Byrne; Günther Deuschl; Peter P De Deyn; Franck Durif; Jaime Kulisevsky; Teus van Laar; Andrew Lees; Werner Poewe; Alain Robillard; Mario M Rosa; Erik Wolters; Peter Quarg; Sibel Tekin; Roger Lane Journal: N Engl J Med Date: 2004-12-09 Impact factor: 91.245
Authors: Annalena Venneri; Michael F Shanks; Roger T Staff; Simon J Pestell; Katrina E Forbes; Howard G Gemmell; Alison D Murray Journal: Neuroreport Date: 2002-01-21 Impact factor: 1.837
Authors: G Stennis Watson; Brenna A Cholerton; Rachel G Gross; Daniel Weintraub; Cyrus P Zabetian; John Q Trojanowski; Thomas J Montine; Andrew Siderowf; James B Leverenz Journal: Alzheimers Dement Date: 2012-11-16 Impact factor: 21.566
Authors: Vikas Kotagal; Roger L Albin; Martijn L T M Müller; Robert A Koeppe; Ronald D Chervin; Kirk A Frey; Nicolaas I Bohnen Journal: Ann Neurol Date: 2012-04 Impact factor: 10.422