Rivastigmine, an acetylcholinesterase inhibitor (AChEI), is the only U.S. approved treatment for mild to moderate dementia in Parkinson’s disease (PDD). However, the real world utilization of rivastigmine and other prescription dementia medications in U.S. PDD patients is unknown.

Cross-sectional retrospective observational study using Truven Marketscan® commercial and Medicare-supplemental administrative claims data.  Patients ≥40 years of age, with continuous enrollment, at least 2 outpatient or 1 inpatient Parkinson’s disease ICD-10-CM diagnosis codes, and at least 2 outpatient or 1 inpatient dementia ICD-10-CM diagnosis codes during the study period from 1-Oct-2015 to 30-June-2017 were selected.  Patients with 1 or more dementia codes indicative of another disease (e.g. Alzheimer’s disease) during the study period were excluded.  Prescription dementia medications received by the selected cohort during the study period are described. 

The final cohort consisted of 1,842 patients, 58.3% male with a mean (SD) age of 77.0 (9.3).  During the study period, 9.8%, 39.8% and 18.6% had at least 1 claim for rivastigmine, any AChEI (includes rivastigmine, donepezil or galantamine) and memantine respectively.  Additionally, 54.0% of patients in the cohort received no prescription dementia medication during the study period.  Patients receiving rivastigmine therapy also received other dementia medications during the study period; 9.9% had a donepezil claim and 34.8% had a claim for memantine. 

Over half of U.S. PDD patients identified for inclusion in this study had no prescription dementia medication claims during the study period. Furthermore, less than 10% of the cohort used the approved PDD medication (rivastigmine) while off-label use of other prescription dementia medications was more common. These results indicate significant unmet treatment need in Parkinson’s disease patients suffering from dementia.