Rivastigmine is associated with improvements in patients with Parkinson’s disease dementia and low blood pressure when standing

This study investigated if orthostatic hypotension (OH) affects the effectiveness of rivastigmine (Exelon) in patients with Parkinson’s disease and dementia (PDD). Researchers suggested that rivastigmine is associated with better outcomes in patients with OH.

Parkinson’s disease (PD) is a chronic disorder that affects the brain cells. These cells lose their abilities to control body functions, which leaves the patients with symptoms such as tremors.

OH is a drop in blood pressure that happens when patients stand up from sitting or lying down. Patients might feel dizzy or lightheaded or even faint. OH is present in 30% of patients with PD. However, it increases to 65% with the progression of PD and the development of dementia (loss of memory and other mental skills). 

Rivastigmine is a drug that improves communication between brain cells. It is recommended for the treatment of patients with progressive PD and dementia (PDD). However, the effectiveness of this therapy in patients who also experience OH is still not known.

This study included information about 1047 patients with progressive PDD. 501 participants were assigned to either rivastigmine or placebo (a drug with no effects on the body). 546 participants were assigned to either a rivastigmine capsule or a rivastigmine patch. The main outcomes measured were cognitive (mental abilities) change at week 24 and dementia symptoms at week 76. These symptoms were compared among patients who had OH and those without OH.

In patients with OH, there was a greater improvement in the cognitive ability at week 24 with rivastigmine compared to placebo. This improvement was smaller in patients without OH treated with rivastigmine.

There were larger improvements in dementia symptoms at week 76 in patients with OH who received rivastigmine capsules when compared to patch. Rivastigmine patch was not associated with differences in dementia symptoms between patients with or without OH.

The overall frequency of OH was lower for the rivastigmine group (28.3%) than the placebo group (44.6%) at week 24. 

Overall, there was no significant difference in side effects in patients with or without OH receiving rivastigmine. However, the frequency of fainting was greater in patients with OH who received a placebo (9.2%) compared to rivastigmine (0%).

This study concluded that rivastigmine is a good and safe therapy for patients with progressive PD, dementia, and OH.

This study included a limited number of patients with OH. Also, this study was funded by Novartis Pharmaceuticals, the manufacturer of rivastigmine.