Objective: The aim of this study is to evaluate, compare and rank the currently available pharmacological cognitive treatments.
Background: Treating cognitive impairment in Parkinson’s disease dementia (PDD) and Lewy body dementias (DLB) continues to pose a significant challenge to clinicians due to several factors. These include limited treatment options, inconsistent daily variability in response to treatment and the lack of precise objective assessments.
Method: We searched PubMed, Psychinfo, Embase, and trials registries from January 2000 to January 2023 to identify Randomized Controlled Trials that assessed cognitive treatments in PDD or DLB. Network Meta-analysis was conducted using the netmeta package in R, and the primary outcome measures were global clinical, cognitive, and neuropsychiatric measures. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) and Cochrane risk-of-bias tool for randomized trials (RoB 2) were used to assess the risk of bias in the studies.
Results: 14 out of 2045 studies identified met the inclusion criteria. The network meta-analysis showed that oral Rivastigmine and Donepezil significantly improved the global cognitive outcome measures in comparison to placebo (Standardised Mean Difference = 0.38 [0.09; 0.66], 0.33 [0.08; 0.59] 95% CI respectively). Oral Rivastigmine, Donepezil and Memantine improved the global clinical outcome significantly when compared to placebo (Standardised Mean Difference = 0.50 [0. 23; 0.77], 0.33[0.08,0.58], 0.40 [0.03; 0.76] 95% CI respectively). None of the treatments showed significant improvement in the neuropsychiatric outcome measures. Rivastigmine was ranked first in all the outcome measures.
Conclusion: Rivastigmine is likely to offer the highest clinical, cognitive, and neuropsychiatric benefits in PDD and DLB patients compared to the other cognitive treatments. More large head-to-head randomized controlled trials are needed for better evaluation and enhancement of our current treatment protocols.
To cite this abstract in AMA style:
F. Al Hajraf, S. Manohar, M. Hu. Comparative efficacy of pharmacological cognitive treatments in Parkinson’s disease and Dementia of Lewy Bodies: systemic review & network meta-analysis [abstract]. Mov Disord. 2023; 38 (suppl 1). https://www.mdsabstracts.org/abstract/comparative-efficacy-of-pharmacological-cognitive-treatments-in-parkinsons-disease-and-dementia-of-lewy-bodies-systemic-review-network-meta-analysis/. Accessed June 15, 2025.« Back to 2023 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/comparative-efficacy-of-pharmacological-cognitive-treatments-in-parkinsons-disease-and-dementia-of-lewy-bodies-systemic-review-network-meta-analysis/