Rivastigmine for Refractory REM Behavior Disorder in Mild Cognitive Impairment

Abstract

Background: Mild Cognitive Impairment (MCI) and REM Behavior Disorder (RBD) are both associated with a degeneration of ponto-medullary cholinergic pathways. Methods: We conducted a placebo-controlled, cross-over pilot trial of Rivastigmine (RVT) in 25 consecutive patients with MCI, who presented RBD refractory to conventional first-line treatments (melatonin up to 5 mg/day and clonazepam up to 2 mg/day). Results: RVT treatment was followed by a significant reduction of RBD episodes when compared with placebo. Conclusions: Our data suggest that, in MCI patients with RBD resistant to conventional therapies (muscle relaxants benzodiazepines or melatonin,) treatment with RVT may induce a reduction in the frequency of RBD episodes compared to placebo. Keywords: Acetylcholine, acetylcholinesterase inhibitors, Alzheimer disease, cholinergic pathways, MCI, mild cognitive impairment, RBD, REM behavior disorder, REM, rivastigmine (RVT), sleep.