Rivastigmine for dementia in people with Down syndrome

The drug rivastigmine has been reported to have benefits for people with mild to moderate Alzheimer's disease who do not have Down syndrome. However, people with DS tend to present with AD at a much younger age than the general population as well as being physically different in terms of size, metabolism and heart rate, and may therefore have different requirements. This review identified no randomised controlled trials of rivastigmine in people with Down syndrome. Further research is needed.

Authors' conclusions: 

As there are no included trials, recommendations cannot be made about rivastigmine for AD in DS. Well-designed, adequately powered studies are required.

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Background: 

Alzheimer's dementia (AD) is the most common form of dementia in people with Down Syndrome (DS). Acetylcholine is a chemical found in the brain that has an important role in memory, attention, reason and language. Rivastigmine is a “pseudo-irreversible” inhibitor of acetylcholinesterase, which is thought to maintain levels of acetylcholine. Rivastigmine can improve cognitive function and slow the decline of AD in the general population over time. It is important to note that people with DS tend to present with AD at a much younger age than the normal population as well as having subtle differences in physiology (e.g. metabolism and heart rate) and may therefore have different requirements from the general population.

Objectives: 

To determine the effectiveness and safety of rivastigmine for people with DS who develop AD.

Search strategy: 

CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, BIOSIS, SCI, SSCI and the NRR were searched up to October 2008. We contacted the manufacturers of rivastigmine as well as experts in the field, to ask about reports of unpublished or ongoing trials.

Selection criteria: 

Randomised controlled trials of participants with DS and AD in which treatment with rivastigmine was administered compared with a placebo group.

Data collection and analysis: 

No study was identified which met inclusion criteria for this review.

Main results: 

No study was identified which met inclusion criteria for this review.

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