Hello,
My gramma (72yrs) just visited the Movement Disorder Specialist and was diagnosed with parkinsons related dementia. He gave her Exelon to try to see if it helps. Does anyone else have this dementia and/or taking Exelon?
Thank you
Melynda

While searching for information on Alzheimer's, I saw that Exelon was recently approved for Parkinson's dimentia.

My wife was diagnosed with PD in 1995 . . takes Mirapex, Sinemet, and Amantadine for PD. Recently has had heavy bouts of hallucination. Her doctor has reduced and attempted to balance her meds over the 24 hour day to see if the meds might be causing the hallucinations. So far this hasn't helped.

I copied the Exelon info, and was going to ask her doctor what he thinks.
I would greatly appreciate hearing of any feedback you receive on this forum or from your own experience.

Thanks . . Tom

Exelon� Granted EU Marketing Authorization As First Treatment For Dementia Associated With Parkinson's Disease By European Commission

09 Mar 2006

Novartis announced today that Exelon� (rivastigmine tartrate) has been granted European marketing authorization by the European Commission for the symptomatic treatment of mild to moderately severe dementia in patients with idiopathic Parkinson's disease (PD) in all 25 European member states.

This makes Exelon, currently indicated for Alzheimer's dementia, the first medication available to treat dementia in Parkinson's patients in the European Union and the only cholinesterase inhibitor to be authorized for more than one type of dementia. Exelon has already received marketing authorization for dementia associated with PD in Switzerland and several Latin American countries, including Brazil.

The EU approval is based on the results of the EXPRESS study, a large-scale, randomized, well-controlled study involving 541 patients from 12 study centers in Europe and Canada and follows the positive opinion granted by the Committee for Medicinal Products for Human Use (CHMP) earlier this year.

"Exelon provides an important advance in the therapy of dementia associated with Parkinson's disease", said Professor Werner Poewe, Head of Neurology, University Hospital, Innsbruck, Austria. "In the EXPRESS study, patients taking Exelon showed significant benefits regarding memory, concentration and behavioral problems. Patients and their caregivers reported in particular an increased interest and ability to conduct social conversations. This does not only translate into a better quality of life for PD patients suffering from dementia but also a substantial improvement in the quality of life for their families," Werner Poewe concluded.

At any one time, up to 40 percent of people with Parkinson's disease suffer from dementia . Patients with dementia associated with Parkinson's disease typically have problems with memory, concentration, activities of daily living, as well as depression, anxiety, apathy and hallucinations . However, probably due to the absence of treatment, current diagnosis rates are low.

"When my husband developed dementia associated with Parkinson's disease, I became a nervous wreck. He would ask me the same question again and again and again," said Mrs I., spouse of PD patient suffering from dementia. "Since he has started taking this new medicine he pays more attention, we have conversations and he can go to the shop by himself. It is wonderful. I know it won't go away completely, but these tablets have really changed our lives. Everything is different now."

About the EXPRESS study

The regulatory submissions were based on the EXPRESS study (EXelon in PaRkinson's disEaSe dementia Study), published in December 2004 in the New England Journal of Medicine . EXPRESS is the first large-scale clinical study assessing the efficacy and safety of any treatment in Parkinson's disease patients with dementia. Patients taking Exelon showed statistically significant benefits on a range of symptoms, such as maintaining or improving memory, concentration and behavioral problems. They were also able to cope better with everyday activities like watching TV or talking about current events.

The side effects associated with Exelon during this study were mild to moderate in nature and included nausea and vomiting. Importantly, motor scale assessments showed that Parkinsonian symptoms were not worsened overall relative to baseline or placebo. Mild to moderate tremor was reported in 10% of Exelon-treated patients, but this resulted in relatively few withdrawals from the study.

About Exelon

Since 1997, Exelon has been widely used to treat mild to moderately severe Alzheimer's dementia in over 70 countries. It belongs to a class of drugs known as cholinesterase inhibitors (ChEI's) which increase the activity of the neurotransmitter acetylcholine in the brain.

Among the ChEI's, Exelon is the only treatment that inhibits both enzymes involved in the breakdown of this neurotransmitter - acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE). This may offer additional benefits over treatments which inhibit AChE alone. Exelon can maintain both memory and thinking, help with behavioral problems and affect how patients cope with the activities of daily living. It may help them communicate better, interact socially, participate in hobbies and in activities of daily living.

About Parkinson's Disease Dementia

Parkinson's disease is a chronic and progressive neurological condition estimated to affect 6.3 million people worldwide . Dementia is thought to occur in up to 40 percent of patients diagnosed with this disease and may affect up to 80 percent of Parkinson's patients in advanced age and severe diseaseError! Bookmark not defined.1, . Parkinson's patients have a six-fold increase in the risk of developing dementia compared with elderly people without Parkinson's disease.

Like Alzheimer's, dementia associated with Parkinson's disease is thought to result partly from a cholinergic deficit, which causes decreased transmission of signals between nerves in the brain, especially those that rely on the neurotransmitter acetylcholine.

Dementia associated with Parkinson's disease differs clinically from Alzheimer dementia. Patients with dementia associated with Parkinson's disease generally suffer from an impairment of executive function like the ability to plan or organize and goal-directed behavior. Furthermore they have more severe visuospatial deficits, apathy, severe attentional deficits with fluctuations and frequent visual hallucinations.

This release contains certain forward-looking statements relating to the Company's business, which can be identified by the use of forward-looking terminology such as "may offer", "may help", "goal is", or similar expressions, or by express or implied discussions regarding potential new indications for Exelon, or regarding potential future revenue from Exelon. Such forward-looking statements involve known and unknown risks, uncertainties and other factors that may cause actual results with Exelon to be materially different from any future results, performance or achievements expressed or implied by such statements. There can be no guarantee that Exelon will be approved for any additional indications in any market or regarding potential future revenue from Exelon. In particular, management's expectations regarding commercialization of Exelon could be affected by, among other things, additional analysis of Exelon clinical data; new clinical data; unexpected clinical trial results; unexpected regulatory actions or delays in government regulation generally; the company's ability to obtain or maintain patent or other proprietary intellectual property protection; competition in general; government, industry, and general public pricing pressures; as well as factors discussed in the Company's Form 20-F filed with the US Securities and Exchange Commission. Should one or more of these risks or uncertainties materialize, or should underlying assumptions prove incorrect, actual results may vary materially from those described herein as anticipated, believed, estimated or expected. Novartis is providing the information in this press release as of this date and does not undertake any obligation to update any forward-looking statements contained in this press release as a result of new information, future events or otherwise.


References

1) Cummings JL. Intellectual impairment in Parkinson's disease: clinical, pathological and biochemical correlates. J Geriatr Psychiatry Neurol 1988;1:24-36.

2) Huber SJ, Paulson GW, Shuttleworth EC. Relationship of motor symptoms, intellectual impairment, and depression in Parkinson's disease. J Neurol Neurosurg Psychiatry 1988;51:855-858.

3) Emre M et al. Rivastigmine for the dementia associated with Parkinson's Disease. N Engl J Med 2004;351:29-38.

4) Corey-Bloom J, Anand R, Veach J. A randomized trial evaluating the efficacy and safety of ENA713 (rivastigmine tartrate), a new acetylcholinesterase inhibitor, in patients with mild to moderately severe Alzheimer's disease. Int J Geriatr Psychopharmacol 1998;1:55-65.

5) R�sler M, Anand R, Cicin-Sain A et al. Efficacy and safety of rivastigmine in patients with Alzheimer's disease: international randomized controlled trial. Br Med J 1999;318:633-40.

6) Global Declaration on Parkinson's Disease launched by the Working Group on PD at the 7th World PD International Symposium, 7th December 2003 in Mumbai, India. http://www.epda.eu.com/globaldeclaration-about.shtm.

7) McKeith IG and Mosimann UP. "Dementia with Lewy bodies and Parkinson's disease." Parkinsonism & Related Disorders 10 (2004) S15-S18.

8) Aarsland D, Andersen K, Larsen JP, Lolk A, Nielsen H, Kragh-Sorensen P.Risk of dementia in Parkinson's disease: a community-based, prospective study. Neurology. 2001;56(6):730-6.

Article URL: http://www.medicalnewstoday.com/medi...p?newsid=39135

National Parkinson Foundation (NPF)
http://www.parkinson.org/site/pp.asp...LPwB&b=1816905

The U.S. Food and Drug Administration Approves Exelon® (rivastigmine tartrate) as the First Medication Indicated to Treat Parkinson's Disease Dementia

• An estimated 40% of Parkinson's disease patients develop dementia
• The risk of developing dementia is approximately four to six times higher among Parkinson's patients than among elderly people without the disease

East Hanover, NJ, June 27, 2006 - Novartis Pharmaceuticals Corporation announced today that the U.S. Food and Drug Administration (FDA) has approved Exelon (rivastigmine tartrate) for the treatment of mild to moderate Parkinson's disease dementia, making Exelon the first medication available for the treatment of this condition. Exelon is also indicated for the treatment of mild to moderate Alzheimer's disease.

According to the National Parkinson Foundation (NPF), Parkinson's disease affects 1.5 million Americans. Approximately 40% of patients with Parkinson's disease are estimated to also develop dementia, which can have a devastating effect on patients and their families. The risk for developing dementia among Parkinson's patients is approximately four to six times higher than among elderly people without this disease. According to the NPF, dementia is one of the complications most feared by Parkinson's disease patients and their caregivers.

"Parkinson's disease dementia takes a significant emotional, economic and social toll on patients and their families," said Laura Marsh, MD, Director, Clinical Research Program Johns Hopkins Morris K. Udall Parkinson's Disease Research Center and member of the American Parkinson Disease Association Scientific Advisory Board. "With current Parkinson's disease treatments, we are often able to manage the movement symptoms of the disease, but there has been a significant gap in our ability to treat dementia in these patients, which is why this approval is such a welcome development."

The approval of Exelon for the treatment of Parkinson's disease dementia follows a unanimous recommendation in favor of approval from the FDA's Peripheral and Central Nervous System Drugs Advisory Committee on May 17, 2006, which was based on results from the EXelon in PaRkinson's disEaSe dementia Study (EXPRESS). EXPRESS is the first large-scale, prospective, randomized, double-blind, placebo-controlled, multicenter study with an Alzheimer's disease medication to demonstrate statistically significant improvement in the treatment of symptoms of Parkinson's disease dementia.

Published in the New England Journal of Medicine in December 2004, EXPRESS included 541 patients and is the first and only prospective, large-scale trial to show benefits in patients with Parkinson's disease dementia. The outcomes were better in patients treated with Exelon compared to placebo (sugar pill) in both the primary and secondary variables. There was statistically significant improvement in overall functioning in patients treated with Exelon relative to deterioration seen in those treated with placebo, in cognition and certain aspects of behavior. Patients treated with Exelon also had less deterioration in their ability to perform activities of daily living than patients who received placebo. Patients enrolled in the study had mild to moderately severe dementia, which developed at least two years after they were diagnosed with Parkinson's disease.

"The outcomes demonstrated in this trial by patients taking Exelon can translate into meaningful gains -- such as taking a more active role in everyday life, interacting with loved ones, and maintaining independence longer -- all of which can make a real difference for both patients and their families," said Jeffrey Cummings, MD, Professor of Neurology at the University of California, Los Angeles. "Exelon has consistently demonstrated efficacy in the treatment of Alzheimer's disease patients and can now also benefit individuals living with Parkinson's disease dementia."

In March 2006, Exelon was granted European marketing authorization for the treatment of Parkinson's disease dementia in all 25 European member states, making it the only medication available to treat the condition in the European Union. Exelon has also been approved to treat Parkinson's disease dementia in 14 other countries around the world.

New Nationwide Survey Underscores Impact of the Condition and Need for Effective Treatments
A nationwide survey of 660 U.S. adults caring for a loved one with Parkinson's disease conducted by Harris Interactive® recently showed that the impact of Parkinson's disease is significantly affected by whether or not their loved one has dementia. Compared to caregivers of Parkinson's patients without dementia, caregivers for patients with Parkinson's disease dementia spend twice as many hours per day taking care of their loved one. In addition, they are significantly more likely to describe themselves as feeling frustrated, depressed, overwhelmed, emotionally drained, physically exhausted or unable to cope. Perhaps the most compelling measures of the toll taken by Parkinson's disease dementia are the facts that caregivers are nearly three times as likely to have hired full or part time professional help to provide care; and they are twice as likely to have sought help for themselves from a medical or mental healthcare provider.

The survey also found that nearly nine in ten people caring for a loved one with Parkinson's disease dementia believe their family member's quality of life would improve and that it would be easier to care for their loved one if there were an effective treatment available for the condition.

About Parkinson's Disease Dementia
Parkinson's disease is a chronic and progressive disease of the nervous system. The four primary symptoms of Parkinson's include: rigidity of the limbs; tremor (trembling or shaking) of a limb, especially when the body is at rest; slow movement and postural instability, which is often perceived as unsteadiness or lack of balance.

The primary symptoms of Parkinson's disease dementia include cognitive impairment and neuro-psychiatric symptoms (e.g., depression, hallucinations, anxiety and apathy). These symptoms impact the patient's quality of life, course of the disease and caregiver distress. As with Alzheimer's disease, Parkinson's disease dementia is associated with a cholinergic deficit, which results in decreased transmission of signals between nerves in the brain, especially those that rely on the neurotransmitter acetylcholine. This deficit contributes to the cognitive and behavioral problems observed in these patients.

About the Survey
Harris Interactive conducted the survey on behalf of Novartis Pharmaceuticals Corporation. The 15-minute survey was administered online from April 19 - May 24, 2006. Responses from 660 U.S. adults (age 22 and older) who are taking care of a friend or family member suffering from Parkinson's disease (PD) were analyzed. Respondents were recruited from three sources: Harris Interactive's online caregiver panel; a mass mailing conducted by the American Parkinson Disease Association (APDA); and a link on the National Parkinson Foundation (NPF) website.

The results were then weighted using demographic variables including age by sex, household income, education, race, and geographic region and a variable called a propensity score that captures attitudinal and behavioral differences between those who are online versus those who are not, those who join online panels versus those who do not, and those who responded to this survey invitation versus those who did not. Harris Interactive's proprietary propensity weighting approach helps to minimize both demographic and attitudinal biases to ensure that the survey's results are projectable to the U.S. population of Parkinson's caregivers, including those with and without internet access.

Safety Information About Exelon
In the EXPRESS study Exelon was generally well tolerated. The most frequent side effects associated with Exelon were nausea and vomiting, which were mild to moderate in nature. More patients treated with Exelon reported increased tremor than did patients on placebo, but this rarely resulted in withdrawal from the study and the rating scale used to measure motor function in Parkinson's disease (UPDRS III) did not show a significant deterioration relative to baseline nor a statistically significant increase in tremor between Exelon and placebo.

Exelon is also approved for the treatment of mild to moderate Alzheimer's disease. It has been administered to over 3 million patients worldwide and is cleared for marketing in over 70 countries.

Exelon use is associated with significant stomach-related side effects, including nausea, vomiting, loss of appetite, and weight loss. If therapy is interrupted for longer than several days, treatment should be reinitiated with the lowest daily dose in order to avoid the possibility of severe vomiting and its potentially serious consequences.

In clinical studies, stomach-related side effects occurred more frequently as doses were increased. The weight loss associated with Exelon occurred more commonly among women receiving high doses in clinical studies. Because these side effects can be serious, caregivers should be encouraged to monitor for these adverse events and inform the physician if they occur. People at risk for certain heart conditions or stomach ulcers should notify their doctor before starting Exelon therapy. In clinical studies, some patients also experienced fainting, weakness, and upset stomach.

The foregoing press release contains forward-looking statements that can be identified by forward-looking terminology, such as "would improve" or implied statements regarding potential future approvals of, or potential future revenues from Exelon. Such statements involve known and unknown risks, uncertainties and other factors that may cause the actual results to be materially different from any future results, performance, or achievements expressed or implied by such statements. There can be no guarantee that Exelon will reach any particular sales levels. In particular, management's expectation regarding the commercial success of Exelon could be affected by among other things, uncertainties relating to product development, regulatory actions or delays or government regulation generally, the ability to obtain or maintain patent or other proprietary intellectual property protection and competition in general, as well as factors discussed in the Form 20F filed with the Securities and Exchange Commission. Should one or more of these risks or uncertainties materialize, or should underlying assumptions prove incorrect, actual results may vary materially from those described herein anticipated, believed, estimated or expected. Novartis is providing the information in this press release as of this date and does not undertake any obligation to update any forward-looking statements contained in this press release as a result of new information, future events or otherwise.

About Novartis
Novartis Pharmaceuticals Corporation develops, manufactures, markets and sells leading innovative prescription drugs used to treat a number of diseases and conditions, including those in the cardiovascular, metabolic, cancer, organ transplantation, central nervous system, dermatological, gastrointestinal and respiratory areas. The company's mission is to improve people's lives by pioneering novel healthcare solutions.

Novartis has been a leader in the neuroscience area for more than 50 years, having pioneered early breakthrough treatments for Alzheimer's disease, Parkinson's disease, Attention Deficit Hyperactivity Disorder, epilepsy, schizophrenia and migraine, many of which continue to be regarded as "gold standards" to this day. Novartis Neuroscience continues to be at the forefront of research and development of new compounds, is committed to addressing unmet medical needs and to supporting patients and families affected by these disorders.

Located in East Hanover, New Jersey, Novartis Pharmaceuticals Corporation is an affiliate of Novartis AG (NYSE: NVS) - a world leader in offering medicines to protect health, treat disease and improve well-being. Our goal is to discover, develop and successfully market innovative products to treat patients, ease suffering and enhance the quality of life. Novartis is the only company with leadership positions in both patented and generic pharmaceuticals. We are strengthening our medicine-based portfolio, which is focused on strategic growth platforms in innovation-driven pharmaceuticals, high-quality and low-cost generics and leading self-medication OTC brands. In 2005, the Group's businesses achieved net sales of USD 32.2 billion and net income of USD 6.1 billion. Approximately USD 4.8 billion was invested in R&D. Headquartered in Basel, Switzerland, Novartis Group companies employ approximately 91,000 people and operate in over 140 countries around the world.

This may not be the kind of hallucinations your wife is having, but when I took 200 mg per day of Amantadine I saw green and pink lace patterns on all white surfaces: ceiling, bathtub, sink, etc. The patterns were quite distinct and very pretty, but also disconcerting.
I cut the Amantadine down to 100 mg per day, and the lace disappeared. I do at times still see a fine, dark grey 'mesh' pattern, but it is faint and goes away when I focus my eyes on it.
My Neurologist does not think the lace was connected to Amantadine, but I know that it was. Your wife might try to cut down on the Amantadine and see if that helps.
Someone else in this forum had an episode of hallucination from Mirapex, so that might be the culprit.

Melynda, it doesn't appear that you're getting a direct reply to your post,
"Exelon for PD dementia",
but yesterday I went to the doctor and took an article about Exelon with me, and he said that he would rather prescribe Razadyne because he has had fewer complaints about Nausea and Vomiting.
He did not elaborate
He gave me a Razadyne sample to try for 8 weeks, and I didn't press for more info, because I was in in between his regular appointments.

It also appears that there are different kinds of hallucinations . . my wife, Elinor is seeing things that are not there or happening, like there are critters in the house or our giant popular tree is moving up and down to let our neighbors cat pass under. As you can see BEMM talked about seeing "green and pink lace patterns on all white surfaces"
(We have tried adjusting Elinor's PD medications, but that hasn't helped at all)

Regards . . Tom