Investigating the effect of rivastigmine on postural control in Parkinson's disease dementia

Authors: McDonald, Jaime
Advisor: Corbeil, Philippe
Abstract: Objectives: To compare the efficacy and safety of oral and transdermal rivastigmine for postural instability in patients with Parkinson’s disease dementia (PDD) who were candidates for a cholinesterase inhibitor. The primary outcome was the change in mean velocity of the centre of pressure (CoP) after 6 months. Secondary outcomes included structural parameters of dynamic posturography, clinical rating scales and adverse events requiring dose reduction. Methods: Patients with PDD were randomized in a 1:1 ratio to oral or transdermal rivastigmine with target doses of 6 mg twice daily and 9.5 mg/10 cm2 daily, respectively. Outcomes were assessed at baseline and 6 months. Results were compared within and between groups. Results: Nineteen patients completed the study (n=8 oral, n=11 transdermal). Mean daily doses of 9.4 mg (± 1.5 mg) and 16.4 mg (± 3.6 mg) were achieved in the oral and transdermal groups, respectively. The transdermal group demonstrated a significant 15.8% decrease in mean velocity of CoP (patch: p <0.05; oral: 10.0% decrease, p=0.16) in the most difficult scenario (eyes closed with sway-referenced support). There was no difference between groups (p=0.27). For structural parameters, significant improvements were seen in the mean duration of peaks (patch) and inter-peak distance (oral) in the most difficult condition. No changes were observed in clinical rating scales. Six patients experienced non-serious adverse events requiring dose reduction (n= 5 oral; n=1 transdermal). Conclusions: Rivastigmine may improve certain elements of postural control, notably the mean velocity of CoP. Benefits appear to be more obvious under more taxing sensory conditions.
Document Type: Mémoire de maîtrise
Issue Date: 2018
Open Access Date: 5 July 2018
Permalink: http://hdl.handle.net/20.500.11794/30262
Grantor: Université Laval
Collection:Thèses et mémoires

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