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Rivastigmine in PDD — MRCPsych Paper B MCQ

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HardOld Age PsychiatryRivastigmine in PDDMRCPsych Paper B

An 80-year-old man with mild-to-moderate Parkinson's disease dementia is started on rivastigmine capsules 1.5 mg twice daily. The pivotal 24-week placebo-controlled EXPRESS study demonstrated an overall cognitive benefit, and dedicated secondary analyses examined domains particularly relevant to the cognitive profile of Parkinson's disease dementia. Which domain pair showed specific treatment-related benefit with rivastigmine?

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Correct answer: E — Attention and executive function

Explanation lettering: D = shown as A · E = shown as B · B = shown as C · A = shown as D · C = shown as E

C is correct. Parkinson's disease dementia commonly has a fluctuating, dysexecutive cognitive profile, with prominent attentional and executive dysfunction. Secondary analyses of the EXPRESS rivastigmine trial demonstrated improvements across measures of sustained and focused attention, processing speed, cognitive flexibility, problem-solving and planning. Rivastigmine is nevertheless a broad symptomatic cognitive treatment rather than a drug that acts exclusively on these domains. Visuospatial and episodic-memory impairment can occur in Parkinson's disease dementia, but they are not the domain pair highlighted by the dedicated EXPRESS analyses. Language is usually less prominently affected than attention and executive function. Motor function is not the cognitive treatment target; rivastigmine can instead worsen tremor or other extrapyramidal symptoms.

Reference: Lalli S, Albanese A. Rivastigmine in Parkinson's disease dementia. Expert Review of Neurotherapeutics. 2008;8(8):1181–1188. https://pubmed.ncbi.nlm.nih.gov/18671661/