Objective:
Cholinergic agents with additional nicotinic activity may be useful in PD patients with dementia (PDD) due to marked cholinergic deficits in PDD and striatal nicotinic-dopaminergic interaction. The aim of this study was to evaluate the effect of galantamine in patients with PDD.
Materials and Methods: PD patients with cognitive impairment after at least one year with parkinsonism received galantamine for 8 weeks. Outcomes were global impression of change (GIC) of parkinsonism and mental symptoms, Neuropsychiatric Inventory (NPI), and cognitive tests.
Results: 15 patients (6 female) at two independent centres were included (10 in Norway, 5 in the U.S.). 13 were demented according to DSM-IV criteria. Age (mean, SD) was 75.4 (5.0) years, duration of PD 13.7 (7.0), and duration of cognitive impairment 2.3 (2.2) years, Hoehn & Yahr score was 3.6 (0.9) and baseline MMSE score was 17.9 (7.7). Side-effects caused discontinuation in 3 patients, but were rare and mild in the remaining 12. Marked improvement of global mental symptoms was noted in 7 (47%) patients after 8 weeks of treatment. Hallucinations improved in 6 (40%) patients. Most notably, parkinsonism improved in 7 (47%) patients, and was marked in 3. Clear trends towards improvement on MMSE, clock-drawing and verbal fluency were found.
Conclusions: A marked clinical improvement (both physical and mental) was observed in 47% of the patients. Treatment was well tolerated in most patients, and (minimal) worsening of parkinsonism was noted in only two of the completers. To our knowledge, this is the first time that physical improvements have been reported for a second-generation cholinesterase inhibitor in PD with dementia.
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