Exelon(reg) may help people with dementia associated with Parkinson's Disease

Exelon provided significant benefits on a wide range of symptoms such as loss of memory, concentration and behavioral
problems - Patients were also able to cope better with activities of daily living.


Exelon(reg) (rivastigmine tartrate) can provide significant benefits in dementia associated with Parkinson's disease (PD) ,
according to a study published in the New England Journal of Medicine this month.


The study, known as EXPRESS (EXelon in PaRkinson's disEaSe dementia Study), is the first large-scale clinical trial assessing
the efficacy and safety of an Alzheimer's disease treatment in PD patients with dementia. [1] Exelon has been widely used in
Alzheimer's disease dementia since its approval in 1997.



Patients taking Exelon showed statistically significant benefits on a range of symptoms, such as loss of memory,
concentration and behavioral problems.


They were also able to cope better with everyday activities like watching TV or talking about current events.


"The findings of the EXPRESS study could have important implications for clinical practice," said Dr Murat Emre, Professor of
Neurology at the Istanbul University in Turkey, lead investigator of the EXPRESS study.


"With current treatments we are able to manage the movement symptoms of Parkinson's disease quite well, but dementia has been
an area which could not be treated up to now. Rivastigmine is a therapy that has been shown to improve symptoms frequently
seen in patients suffering from dementia associated with PD and thus offers hope to provide a better quality of life," Dr.
Emre said.



Dementia is one of the complications most feared by PD patients. [2] In addition to cognitive impairment, neuro-psychiatric
symptoms like depression, hallucinations, anxiety and apathy, are also common. [3] These symptoms are important determinants
of the patient's quality of life, course of the disease and caregiver distress. [3] Two out of five people with PD develop
dementia over the course of their illness. [4,5] Patients with PD have a six-fold increase in the risk of developing dementia
compared with elderly people without PD.



"Dementia associated with Parkinson's disease places a significant emotional, economic and social burden on patients and
their families," said Mary Baker, President of the European Parkinson's Disease Association, which is based in the United
Kingdom.















"As the person with PD becomes increasingly dependent, watching someone that you care for start to deteriorate in this way is
heart breaking, and the future becomes an uncertain abyss for all the family. Sometimes institutional care is the only option
and this places a significant economic burden on the family and the state. Results like this give new hope to families caring
for a loved one with dementia and may improve the quality of life of the whole family," Baker said.


EXPRESS Study Results


Over a 24-week study period, patients were randomly assigned to a daily dose of 3-12 mg Exelon or placebo. Investigators used
two measures regularly applied in clinical studies of patients with dementia: the Alzheimer's Disease Assessment
Scale-cognition (ADAS-cog) to evaluate patients' cognitive function; and the Alzheimer's Disease Cooperative
Study-Clinician's Global Impression of Change (ADCS-CGIC) to assess the patients' overall functioning.


Patients who were treated with Exelon showed a mean 2.1-point improvement (versus a 0.7-point decline in placebo) on the
ADAS-cog scores (p< 0.001) at week 24 of the study. Mean ratings on the ADCS-CGIC were 3.8 on rivastigmine versus 4.3 on
placebo (p= 0.007). Additional specific tests for memory, attention, behavioral symptoms and verbal fluency consistently
showed significantly better outcomes for Exelon versus placebo (all p