Rivastigmine for cognitive impairment after spontaneous subarachnoid haemorrhage: a pilot study

• Published in: Journal of clinical pharmacy and therapeutics Vol. 34; no. 6; pp. 657 - 663
• Main Authors: Wong, G. K.-C., Wong, R., Mok, V., Wong, A., Fan, D., Leung, G., Chan, A., Poon, W. S.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.12.2009; Blackwell
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; cerebral aneurysm; Cholinesterase Inhibitors - therapeutic use; Cognition Disorders - drug therapy; cognitive deficit; Female; Humans; Male; Medical sciences; Middle Aged; Neurology; Neuropsychological Tests; Pharmacology. Drug treatments; Phenylcarbamates - therapeutic use; Pilot Projects; Rivastigmine; stroke; subarachnoid hemorrhage; Subarachnoid Hemorrhage - complications; Vascular diseases and vascular malformations of the nervous system; cognitive deficit; Nervous system diseases; Stroke; Cognitive disorder; Enzyme; Subarachnoid hemorrhage; Psychotropic; Spontaneous; cerebral aneurysm; Enzyme inhibitor; Cardiovascular disease; Esterases; Antialzheimer agent; Acetylcholinesterase; Carboxylic ester hydrolases; Cerebral disorder; Vascular disease; intracranial aneurysm; Rivastigmine; Nootropic agent; Central nervous system disease; Hydrolases; Anticholinesterase agent; Cerebrovascular disease
• ISSN: 0269-4727; 1365-2710
• DOI: 10.1111/j.1365-2710.2009.01056.x

Summary Background and objective:  Rivastigmine has been shown to be effective for patients with mild‐to‐moderate Alzheimer’s disease. Its effect on cognitive impairment after aneurysmal subarachnoid haemorrhage has not been previously studied. The aim of the study is to evaluate the efficacy and safety of rivastigmine 3 mg/day over 12 weeks in patients with aneurysmal subarachnoid haemorrhage and persistent cognitive impairment. Methods:  Twenty Chinese patients with spontaneous subarachnoid haemorrhage at least 9 months after the initial ictus, and with persistent cognitive impairment, were recruited. The primary outcome measure was Cognitive Subscale of Alzheimer Disease Assessment Scale (ADAS‐cog) for global function; the secondary outcome measures were the Frontal Assessment Battery (FAB) for frontal lobe function and the Rivermead Behavioural Memory Test (RBMT) for prospective memory. Baseline cholinergic dysfunction (with pupillometry) was assessed for relationship with treatment efficacy. Results:  Sixteen of 20 (80%) patients completed the 12‐week course of rivastigmine 1·5 mg twice daily. In comparison with the baseline assessment, ADAS‐cog showed significant improvement after treatment (mean difference 6·5, 95% CI 3·5–9·5, P < 0·001); FAB and RBMT also showed significant improvement. Baseline cholinergic dysfunction (with pupillometry) was not correlated with improvement in ADAS‐cog, FAB or RBMT. Conclusion:  The use of rivastigmine was safe in patients with spontaneous subarachnoid haemorrhage and persistent cognitive impairment. A prospective double‐blind placebo‐controlled trial is required to establish the efficacy of rivastigmine for patients with spontaneous subarachnoid hemorrhage and persistent cognitive impairment and whether it can be translated to improvement in instrumental activity of daily living and quality of life.