Original Research Article
Hallucinations Predict Attentional Improvements with Rivastigmine in Dementia with Lewy BodiesMcKeith I.G.a · Wesnes K.A.b · Perry E.a · Ferrara R.c
aInstitute for Ageing and Health, Newcastle General Hospital, Newcastle upon Tyne, and bCognitive Drug Research Ltd., Reading, UK; cNovartis Pharma SpA, Origgio, Italy
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
The aim of this analysis of the effects of cholinergic therapy in dementia with Lewy bodies was to determine whether rivastigmine-induced benefits in attention and memory could be predicted by the presence of visual hallucinations. At study entry, 74% of patients were hallucinators and 26% were non-hallucinators. The population was analyzed for two-factor scores: power of attention (PoA) and quality of memory (QoM). A significant effect over placebo on PoA was observed in hallucinators at weeks 12 (p = 0.023) and 20 (p = 0.0019), while no treatment effects were seen in non-hallucinators. Significant treatment effects on QoM were not observed in either subgroup. Visual hallucinations predicted greater improvements in PoA, but not QoM. This may reflect the greater cholinergic deficits in areas of the brain responsible for visual hallucinations, offering greater potential for attentional improvement.
© 2004 S. Karger AG, Basel
- McKeith IG, Galasko D, Kosaka K, Perry EK, Dickson DW, Hansen LA, Salmon DP, Lowe J, Mirra SS, Byrne EJ, Lennox G, Quinn NP, Edwardson JA, Ince PG, Bergeron C, Burns A, Miller BL, Lovestone S, Collerton D, Jansen EN, Ballard C, de Vos RA, Wilcock GK, Jellinger KA, Perry RH: Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): Report of the consortium on DLB international workshop. Neurology 1996;47:1113–1124.
- Perry RH, Irving D, Blessed G, Fairbairn A, Perry EK: Senile dementia of Lewy body type: A clinically and neuropathologically distinct form of Lewy body dementia in the elderly. J Neurol Sci 1990;95:119–139.
Hansen L, Salmon D, Galasko D, Masliah E, Katzman R, DeTeresa R, Thal L, Pay MM, Hofstetter R, Klauber M: The Lewy body variant of Alzheimer’s disease: A clinical and pathological entity. Neurology 1990;40:1–8.
- McKeith I, Fairbairn A, Perry R, Thompson P, Perry E: Neuroleptic sensitivity in patients with senile dementia of Lewy body type. BMJ 1992;305:673–678.
- Perry EK, Marshall E, Kerwin J, Smith CJ, Jabeen S, Cheng AV, Perry RH: Evidence of a monoaminergic-cholinergic imbalance related to visual hallucinations in Lewy body dementia. J Neurochem 1990;55:1454–1456.
- Ballard C, Piggott M, Johnson M, Cairns N, Perry R, McKeith I, Jaros E, O’Brien J, Holmes C, Perry E: Delusions associated with elevated muscarinic binding in dementia with Lewy bodies. Ann Neurol 2000;48:868–876.
Piggott M, Ballard C, Khan N et al: Cortical dopamine receptors in DLB and Alzheimer’s disease: Selective D2 receptor reductions in DLB (in preparation).
Clegg A, Bryant J, Nicholson T, McIntyre L, De Broe S, Gerard K, Waugh N: Clinical and cost-effectiveness of donepezil, rivastigmine and galantamine for Alzheimer’s disease: A rapid and systematic review. Health Technol Assess 2001;5:1–137.
- Doody RS, Stevens JC, Beck C, Dubinsky RM, Kaye JA, Gwyther L, Mohs RC, Thal LJ, Whitehouse PJ, DeKosky ST, Cummings JL: Practice parameter: Management of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:1154–1166.
Simpson PM, Surmon DJ, Wesnes KA, Wilcock GK: The cognitive drug research computerized assessment system for demented patients: A validation study. Int J Geriatr Psychiatry 1991;6:95–102.
- Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J: The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308–2014.
- McKeith I, Del Ser T, Spano P, Emre M, Wesnes K, Anand R, Cicin-Sain A, Ferrara R, Spiegel R: Efficacy of rivastigmine in dementia with Lewy bodies: A randomised, double blind, placebo-controlled international study. Lancet 2000;356;2031–2036.
- Wesnes KA, McKeith IG, Ferrara R, Emre M, Del Ser T, Spano PF, Cicin-Sain A, Anand R, Spiegel R: Effects of rivastigmine on cognitive function in dementia with Lewy bodies: A randomised placebo-controlled international study using the cognitive drug research computerised assessment system. Dement Geriatr Cogn Disord 2002;13:183–192.
Folstein M, Folstein S, McHugh P: Mini-Mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975,12:189–198.
- Frey PW, Colliver JA: Sensitivity and response measures for discrimination learning. Learn Motivation 1973;4:327–342.
Wesnes K: The cholinergic cognitive psychopharmacology of early information processing from scopolamine to Alzheimer’s disease. Proc Br Psychol Soc 1997;5:49.
Ayre GA: The Comparative Neuropsychology of Dementia; PhD thesis, Newcastle-upon-Tyne, 1998.
- Ballard CG, Aarsland D, McKeith I, O’Brien J, Gray A, Cormack F, Burn D, Cassidy T, Starfeldt R, Larsen JP, Brown R, Tovee M: Fluctuations in attention. PD dementia vs DLB with parkinsonism. Neurology 2002;59:1714–1720.
- Walker MP, Ayre GA, Ashton CH: A psychophysiological investigation of fluctuating consciousness in neurodegenerative dementias. Hum Psychopharmacol 1999;14:483–489.
- Walker MP, Ayre GA, Cummings JL: Quantifying fluctuation in dementia with Lewy bodies, Alzheimer’s disease and vascular dementia. Neurology 2000;54:1616–1625.
- Walker MP, Ayre GA, Cummings JL, Wesnes K, McKeith IG, O’Brien JT, Ballard CG: The Clinician Assessment of Fluctuation and the One Day Fluctuation Assessment Scale. Br J Psychiatry 2000;177:252–256.
- Walker MP, Ayre GA, Perry EK: Quantification and characterisation of fluctuating cognition in dementia with Lewy bodies and Alzheimer’s disease. Dementia Geriatr Cogn Dis 2000;11:327–335.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.