Rivastigmine treatment appears to improve walking in Parkinson’s patients

by Bruce Sylvester: Researchers report that patients treated with the dementia drug rivastigimine are less likely to fall and are much steadier when walking, compared to patients receiving a placebo

The findings appeared on Jan 12, 2016 in in The Lancet Neurology.

Lead investigator, Dr. Emily Henderson, a Parkinson’s UK research fellow based at the University of Bristol in Bristol UK, said, “With the degeneration of dopamine producing nerve cells, people with Parkinson’s often have issues with unsteadiness when walking. As part of the condition, they also have lower levels of acetylcholine, a chemical which helps us to concentrate – making it extremely difficult to pay attention to walking. We already know that rivastigmine works to treat dementia by preventing the breakdown of acetylcholine, however our study shows for the first time that it can also improve regularity of walking, speed, and balance. This is a real breakthrough in reducing the risk of falls for people with Parkinson’s.”

For this phase II study, the researchers enrolled 130 subjects diagnosed with Parkinson’s, and they randomized 65 to the rivastigmine and 65 to a placebo

Rivastigmine was uptitrated over 12 weeks from 3 mg per day to the target dose of 12 mg per day.

The primary endpoint was the difference in step time variability between the two cohorts at 32 weeks, adjusted for baseline age, cognition, step time variability, and number of falls in the previous year.

The researchers measured step time variability with a triaxial accelerometer during an 18 minute walking task and under three conditions — normal walking, simple dual task with phonemic verbal fluency (walking and naming words beginning with a single letter), and complex dual task switching with phonemic verbal fluency (walking and naming words, alternating between two letters of the alphabet).

At week 32 they found that, compared to subjects assigned to placebo (59 assessed), those assigned to rivastigmine (55 assessed) had significantly improved step time variability for normal walking (p=0·002) and the simple dual task (p=0·045).

Improvements in step time variability for the complex dual task did not differ between groups (p=0·17).

Dr Arthur Roach, Director of Research at Parkinson’s UK, which funded the study said, “Things that may be simple to us, such as walking upstairs or getting up in the middle of the night to get a glass of water, or go to the toilet, are much harder and more dangerous when you could easily fall. You risk breaking bones and then needing an emergency hospital admission. This trial shows that there may be drugs already available, being used for other purposes, that can be tested to help treat Parkinson’s. This takes us a step closer to improving the quality of life and finding better treatments for people with Parkinson’s.”