Treatments for cognitive symptoms in Parkinson’s disease

This study looked the effect of cholinesterase inhibitors on treating Parkinson’s disease. The study showed that cholinesterase inhibitors are effective at treating cognitive mental deficits but have no effect on improving the risk of falls.

Patients with Parkinson’s disease (PD) have symptoms which can be either physical, motor-based problems or cognitive, mental-based problems. Examples of common PD symptoms are walking difficulties and dementia, which can cause patients to fall and injure themselves.

A main cause of these motor and cognitive problems is because of reduced levels of chemicals in the brain. One of these chemicals is called acetylcholine. Treatments that stop the breakdown of acetylcholine are called cholinesterase inhibitors (CHIs). These may be useful at treating some PD symptoms.

This meta-analysis looked at the effect of CHIs to improve cognitive function and reduce the risk of falls in patients with PD. The study included the results of 4 trials that compared the effect of CHIs to placebo (substance with no active effect) in 941 patients. Cognitive function was measured using a questionnaire. The rate of falls was also reported. Other tests measured language and memory function, behavioral changes, disability and motor function.

Patients treated with CHIs were slower to develop cognitive problems compared to those treated with placebo. There was no difference in the rate of falls. Memory and language and behavioral changes were improved in patients treated with CHIs. Disability and motor function were the same between both groups.

Patients treated with CHIs were 2.8 times more likely to experience tremors. The chance of side effects were 86% higher with CHI treatment.

There was a reduced death rate in patients treated with CHIs compared to placebo.

The authors concluded that CHIs are effective at treating cognitive impairments but do not improve the risk of falls. They suggested that treatment should be given wisely as there is also an increased risk of tremor and side effects.