Exelon patch rivastigmine tartrate is a reversible cholinesterase inhibitor
July 2 2015

Pathological changes in dementia of the Alzheimerís type and dementia associated with Parkinsonís disease involve cholinergic neuronal pathways that project from the basal forebrain to the cerebral cortex and hippocampus. These pathways are thought to be intricately involved in memory, attention, learning, and other cognitive processes. While the precise mechanism of rivastigmine's action is unknown, it is postulated to exert its therapeutic effect by enhancing cholinergic function.

Exelon (rivastigmine tartrate, Novartis) is a prescription medication pproved by the FDA for the treatment of mild-to-moderate dementia (chronic loss or impairment of intellectual capacity) associated with Parkinson's disease.

Cochrane Database Syst Rev. 2013 May 31. Rivastigmine for vascular cognitive impairment. Vascular dementia represents the second most common type of dementia after Alzheimer's disease. In older patients, in particular, the combination of vascular dementia and Alzheimer's disease is common, and is referred to as mixed dementia. The classification of vascular dementia broadly follows three clinico-pathological processes: multi-infarct dementia, single strategic infarct dementia and subcortical dementia. Not all victims fulfil strict criteria for dementia and may be significantly cognitively impaired without memory loss, when the term vascular cognitive impairment (VCI) is more useful. Currently, no established standard treatment for VCI exists. Reductions in acetylcholine and acetyltransferase activity are common to both Alzheimer's disease and VCI, raising the possibility that cholinesterase inhibitors - such as rivastigmine - which are beneficial in Alzheimer's disease, may also be beneficial for VCI. There is some evidence of benefit of rivastigmine in VCI from trial data from three studies. However, this conclusion is based on one large study. Rivastigmine is capable of inducing side effects that lead to withdrawal in a significant proportion of patients.

J Mov Disord. 2015. Effect of Rivastigmine on Behavioral and Psychiatric Symptoms of Parkinson's Disease Dementia. A recent study showed that rivastigmine and memantin improved behavioral and psychiatric symptoms of dementia (BPSD) in Alzheimer's dementia. Furthermore, according to recent guidelines presented by the Movement Disorder Society, rivastigmine is efficacious for the treatment of dementia in Parkinson's disease (PD). We investigated the efficacy of rivastigmine for BPSD in patients with Parkinson's disease dementia (PDD). Although controlled trials are required, the findings suggest that rivastigmine is useful for control of several neuropsychiatric symptoms and beneficial for caregiver distress in patients with PDD.