Rivastigmine May Be Helpful in Subcortical Vascular Dementia

Laurie Barclay, MD

November 22, 2002

Nov. 22, 2002 — Rivastigmine (Exelon), which was developed for treatment of Alzheimer's disease, also is beneficial in subcortical vascular dementia, according to results of an open-label study reported in the Nov. 15 issue of the Journal of the Neurological Sciences.

"This is the first study to evaluate the safety and efficacy of rivastigmine in patients with subcortical vascular dementia, a common condition for which there are currently few therapeutic options," lead author Rita Moretti, MD, from the University of Trieste in Italy, says in a news release. "These findings are promising because they suggest that rivastigmine provides benefits in these patients, and also may reduce stress levels among the patients' caregivers."

Rivastigmine is a dual inhibitor of acetylcholinesterase and butyrylcholinesterase. In a 22-month open study, 16 patients aged 65 to 80 years with probable vascular dementia received rivastigmine, 3 mg/day, increasing to 6 mg/day after four weeks (n=8), or cardioaspirin, 100 mg/day (n=8).

At 22 months, the rivastigmine group had significant improvements in executive function, behavioral symptoms, and reduced caregiver stress (all P<.05 compared with baseline and with the aspirin group). Patients receiving rivastigmine maintained their baseline scores of global response, cognition, word fluency, and activities of daily living, and they did not increase their benzodiazepine or neuroleptic intake. The aspirin group had no documented improvements and had significant deterioration in global response and executive function (both P<.05 vs. baseline and rivastigmine group).

No patients withdrew from the study, and adverse effects in both groups were tolerable. The most frequent adverse effect in both groups was transitory nausea, which resolved spontaneously during treatment. Vomiting, loss of appetite, weight loss, fainting, and weakness have also occurred in some patients treated with rivastigmine, but no serious adverse events, cardiac problems, or drug interactions were reported in this study.

"Long-term rivastigmine treatment appeared to be safe and effective in this patient population," the authors write. "These benefits may reflect the drug's dual inhibitory effects on the cholinergic system, and its particular activity in frontal areas of the brain."

Novartis, which supported this study, is conducting an ongoing, large-scale, double-blind clinical trial with Exelon in vascular dementia.

J Neurol Sci. 2002;203-204(C):141-146

Reviewed by Gary D. Vogin, MD