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A Randomized Trial of Oral and Transdermal Rivastigmine for Postural Instability in Parkinson Disease Dementia

McDonald, Jaime, PharmD*†; Pourcher, Emmanuelle, MD‡§; Nadeau, Alexandra, PhD; Corbeil, Philippe, PhD

doi: 10.1097/WNF.0000000000000275
Original Articles

Objectives The objective of this study was to compare the efficacy and safety of oral and transdermal rivastigmine for postural instability in patients with Parkinson disease dementia (PDD) who were candidates for a cholinesterase inhibitor. The primary outcome was the change in mean velocity of the center of pressure (CoP) after 6 months. Secondary outcomes included structural parameters of dynamic posturography, clinical rating scales, and adverse events requiring dose reduction.

Methods Patients with PDD were randomized in a 1:1 ratio to oral or transdermal rivastigmine with target doses of 6 mg twice daily and 9.5 mg/10 cm2 daily, respectively. Outcomes were assessed at baseline and 6 months. Results were compared within and between groups.

Results Nineteen patients completed the study (n = 8 oral, n = 11 transdermal). Mean daily doses of 9.4 (±1.5 mg) and 16.4 (±3.6 mg) were achieved in the oral and transdermal groups, respectively. The transdermal group demonstrated a significant 15.8% decrease in mean velocity of CoP (patch: P < 0.05; oral: 10.0% decrease, P = 0.16) in the most difficult scenario (eyes closed with sway-referenced support). There was no difference between groups (P = 0.27). For structural parameters, significant improvements were seen in the mean duration of peaks (patch) and interpeak distance (oral) in the most difficult condition. No changes were observed in clinical rating scales. Six patients experienced nonserious adverse events requiring dose reduction (n = 5 oral; n = 1 transdermal).

Conclusions Rivastigmine may improve certain elements of postural control, notably the mean velocity of CoP. Benefits appear to be more obvious under more taxing sensory conditions.

*Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec City, QC;

Department of Pharmacy, Children’s Hospital of Eastern Ontario, Ottawa, ON;

Department of Neurological Science, CHU de Québec, Quebec City, QC;

§Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, QC;

Department of Psychology, Faculty of Arts and Science, Université de Montréal, Montreal, QC; and

Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec City, QC, Canada.

Address correspondence and reprint requests to Philippe Corbeil, PhD, Pavillon de l’Éducation Physique et des Sports, Département de Kinésiologie, 2300 rue de la Terrasse, Université Laval, Quebec City, QC, Canada, G1V 0A6; E-mail:

Conflicts of Interest and Source of Funding: J. M. was supported by a grant from the Fonds de recherche du Québec – Santé (FRQS). This study was partly supported by a Discovery Grant from NSERC to PC (RGPIN # 327604).

Author Contributions: E.P. worked on the conception and design. A. N. and E. P. were responsible for the collection and assembly of data. J. M., E. P., A. N., and P. C. contributed on the analysis and interpretation of data. J. M., E. P., and P. C. worked on the critical revision of the article for important intellectual content. Lastly, J. M., E. P., A. N., and P. C. were responsible for the final approval of the article.

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