+AA
Fr
McMasterLogo_New-2017-300x165
Back
Evidence Summary

What is an Evidence Summary?

Key messages from scientific research that's ready to be acted on

Got It, Hide this
  • Rating:

Cholinesterase inhibitors slow cognitive decline and do not affect falls in people with Parkinson’s disease

Pagano G, Rengo G, Pasqualetti G, et al. Cholinesterase inhibitors for Parkinson`s disease: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2014 Sep 15. Epub ahead of print.

Review question

In people with Parkinson’s disease who do not have dementia, what is the effect of cholinesterase inhibitors on cognitive function compared with placebo?

Background

Parkinson's disease is a disorder of the nervous system that affects movement. Physical signs of the disease may include tremor (shaking), slowed movement, rigid muscles, impaired posture and balance, and speech and writing changes. Non-physical signs may include impaired cognitive function. Donepezil (Aricept®), rivastigmine (Exelon®) and galantamine (Razadyne®) are cholinesterase inhibitors, a class of drugs that has been used to treat Alzheimer’s disease.

How the review was done

The researchers did a systematic review, searching for published studies up to May 2014. They found 4 randomized controlled trials, with 941 people (average age 68 to 74 years, 39% to 86% men).

People in the studies had Parkinson’s disease. Studies of people with dementia with Lewy bodies were not included.

Any dosage of rivastigmine, donepezil, or galantamine for at least 4 weeks was compared with placebo.

What the researchers found

1 trial was of high quality. The other 3 had unclear quality.

1 trial assessed rivastigmine, and 3 assessed donepezil. No trials assessed galantamine.

Compared with placebo, cholinesterase inhibitors

  • slowed cognitive decline;
  • did not affect falls; and
  • increased rates of tremor and adverse drug reactions.

Conclusions

Cholinesterase inhibitors slow cognitive decline and do not affect rate of falls. They increase tremor and adverse drug reactions.

Cholinesterase inhibitors vs placebo in people with Parkinson’s disease

Outcomes

Number of trials (number of people)

Rate of events with cholinesterase inhibitors

Rate of events with placebo

Effect of cholinesterase inhibitors at 10 to 24 weeks

Mini-Mental State Examination

4 trials (982 people)

 

 

Slower decline in cognition

Death

3 trials (920 people)

0.89%

3.3%

About 24 fewer people out of 1000 died*

Falls

3 trials (873 people)

6.3%

6.9%

No difference in rate of falls†

Tremor

2 trials (834 people)

10%

3.5%

About 65 more people out of 1000 had tremors

Adverse drug reactions

3 trials (936 people)

61%

42%

About 19 more people out of 100 had adverse drug reactions

*Based on a small number of deaths, and therefore the result may not be reliable.

†Although the rates for the 2 groups look a little different, the differences were not statistically significant. This means that the differences could simply be due to chance rather than due to the different treatments.



Related Topics


Glossary

Cognitive function
Mental processes, including thinking, learning and remembering.
Placebo
A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

Related Web Resources

  • Multiple Sclerosis: Should I Start Taking Medicines for MS?

    OHRI
    This patient decision aid helps people with multiple sclerosis decide on whether or not to start taking medicine by comparing the benefits, risks, and side effects of both options.
  • Sorry, what did you say? Living with dysarthria (unclear speech) after stroke

    Evidently Cochrane
    After suffering a stroke, your speech may be unclear depending on which part of your brain was damaged. Better quality research is needed to learn more about how this condition affects people who are recovering from a stroke. This resource includes a personal story from Annette.
  • Bell's palsy

    UpToDate - patient information
    Bell's palsy is a condition that weakens the muscles on one side of your face. A drooping of the eyelid or the corner of the mouth are common signs. Most people recover completely. Getting treatment quickly can help speed your recovery.
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Register for free access to all Professional content

Register
Want the latest in aging research? Sign up for our email alerts.
Subscribe

Support for the Portal is largely provided by the Labarge Optimal Aging Initiative. AGE-WELL is a contributing partner. Help us to continue to provide direct and easy access to evidence-based information on health and social conditions to help you stay healthy, active and engaged as you grow older. Donate Today.

© 2012 - 2020 McMaster University | 1280 Main Street West | Hamilton, Ontario L8S4L8 | +1 905-525-9140 | Terms Of Use