Cholinesterase inhibitors are an effective treatment for patients with Parkinson’s disease with dementia


People with Alzheimer’s disease experience a loss of nerve cells that use a chemical called acetylcholine as a chemical messenger. Dementia symptoms become more severe as more nerve cells are lost.

Cholinesterase inhibitors are a group of drugs (including donepezil, rivastigmine and galantamine) that prevent the enzyme acetylcholinesterase from breaking down acetylcholine in the brain. All three drugs work in a similar way, but they have quite different side-effect profiles in different people.

At present, rivastigmine is the only cholinesterase inhibitor licensed for treating mild to moderate dementia in Alzheimer’s disease and Parkinson’s disease in the UK. Donepezil and galantamine are only licensed in mild to moderate Alzheimer’s disease.

A new Cochrane systematic review has recently been published that seeks to assess the efficacy, safety and tolerability of cholinesterase inhibitors in three different conditions:

  1. Dementia with Lewy bodies
  2. Parkinson’s disease with dementia
  3. Cognitive impairment in Parkinson’s disease falling short of dementia

The reviewers conducted a systematic search but only found 6 trials to included in their reviewer, involving total of 1,236 patients:

  • 1 trial included patients with dementia with Lewy bodies
  • 4 trials included participants with a diagnosis of Parkinson’s disease with dementia
  • 1 trial included patients with cognitive impairment and Parkinson’s disease (both with and without dementia)

Here’s what they found:

  • Cholinesterase inhibitors had a positive impact on global assessment, cognitive function, behavioural disturbance and activities of daily living in patients with Parkinson’s disease with dementia
  • The effect of cholinesterase inhibitors remains unclear in patients with Dementia with Lewy bodies
  • They found no evidence to support the use of cholinesterase inhibitors in patients with cognitive impairment in Parkinson’s disease falling short of dementia


Rolinski M, Fox C, Maidment I, McShane R. Cholinesterase inhibitors for dementia with Lewy bodies, Parkinson’s disease dementia and cognitive impairment in Parkinson’s disease. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD006504. DOI: 10.1002/14651858.CD006504.pub2.

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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