Abstract Details

Title Cholinesterase Inhibitor Taper Worsens Symptoms in Patients with Parkinson’s Disease

Topic Movement Disorders

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 10-046

Objective To determine the effects of tapered discontinuation of cholinesterase inhibitors.

Background While approved for treatment of Alzheimer’s disease (AD), cholinesterase inhibitors are used off label not only for other dementias, but also Parkinson’s Disease and related conditions. While patients themselves frequently discontinue these medications, there are few randomized studies of their discontinuation in a controlled fashion.

Design/Methods Participants who had taken a stable dose of a cholinesterase inhibitor for more than one year were enrolled in a double-blind, placebo-controlled tapered discontinuation study. They were randomized to either a “real taper” (at half-dose for 3 weeks and then placebo for three weeks), or to “sham taper” (meaning they continued to take their pre-study medication/dose). In addition to patients with diagnoses of probable AD, Vascular dementia, or MCI, six participants with Parkinson’s disease-related dementia (PDD) enrolled in the study.

Results All three of the six PDD participants who were randomized to the “real taper” arm chose to discontinue the study drug between 1-2 weeks after beginning the placebo, and to return to their previous dose of donepezil. All three reported increased confusion, delusions, and decline in judgement and attributed the worsening to the study medication (placebo). One demonstrated improved cognition over his pre-study baseline with resumption of his donepezil. None of the three PDD participants on the “sham taper” discontinued the study medication or reported any changes in cognition or behavior. Based on these results, the study has now added PDD as an exclusion criteria for enrollment.

Conclusions Although preliminary, our findings suggest caution regarding discontinuation of cholinesterase inhibitors in PDD, and provide indirect support to the utility of their use in PDD.

Authors/Disclosures
Lauren R. Moo, MD, FAAN (VA Bedford Healthcare System) PRESENTER	Dr. Moo has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Pilltrax. An immediate family member of Dr. Moo has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Taylor and Francis. Dr. Moo has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Smith Mirabella Blake. The institution of Dr. Moo has received research support from VA HSR&D. The institution of Dr. Moo has received research support from VA Office of Rural Health. Dr. Moo has received research support from NIH.
	No disclosure on file
	No disclosure on file
	No disclosure on file

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