Analyzing ChEIs to Treat Psychotic Symptoms of Parkinson’s and Alzheimer’s Disease

The following is a summary of “Cholinesterase Inhibitors for Treatment of Psychotic Symptoms in Alzheimer Disease and Parkinson Disease,” published in the June 2023 issue of Neurology by d’Angremont et al.

Psychotic symptoms in neurodegenerative disorders can be severe and burdensome. Cholinesterase inhibitors (ChEIs) may be effective for these symptoms.

Researchers performed a retrospective study to assess the effectiveness of ChEIs in treating hallucinations and delusions in people with Alzheimer’s disease (AD), Parkinson’s disease (PD), and dementia with Lewy bodies (DLB).

The randomized clinical trials with at least one treatment arm using donepezil, rivastigmine, or galantamine in AD, PD, or DLB patients were selected. Reviewers performed and verified study selection with primary outcomes: hallucinations and delusions; secondary effects include neuropsychiatric subdomains.

The results showed 34 trials, and data from 6,649 individuals (62.6% women; mean age 75.0 [8.2] years) were obtained from 17 trials (AD: n=12; PD: n=5; no data for DLB). ChEI treatment associated with AD subgroup delusions (−0.08; 95% CI, −0.14 to −0.03; P=0.006) and hallucinations (−0.09; 95% CI, −0.14 to −0.04; P=0.003) and PD subgroup delusions (−0.14; 95% CI, −0.26 to −0.01; P=0.04) and hallucinations (−0.08; 95% CI −0.13 to −0.03; P=0.01). Investigators concluded ChEI treatment improves psychotic symptoms in AD and PD with small effect sizes.


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