Never Events Common in Parkinson, Donepezil Fails to Prevent Psychosis, Helping Patients Live Well


Neurology News Network for the week of October 6, 2018.

This week, Neurology News Network covered findings that revealed that 'never events' in prescribing habits are more common than thought for patients with Parkinson disease, donepezil's apparent inability to prevent the development of psychosis in Parkinson, and Dr. Neepa Patel's thoughts on treating patients with Parkinson. Also, a conversation with Dr. Roberto Espay about the need for clinicians to change the way they think about Parkinson as a single disease process. (Transcript below.)


Welcome to Neurology News Network. I’m Jenna Payesko.


And I’m Matt Hoffman. Let’s get into the news from this week.

A cross-sectional analysis has revealed some troubling data regarding patients with comorbid Parkinson disease and dementia. Never events in medication prescribing appear to be more common than previously thought. The never event in question was the co-prescription of a high-potency anticholinergic medication and an acetylcholinesterase inhibitor, which can result in pharmacologic antagonism due to the drugs’ opposing mechanisms of action.

Ultimately, after including data from more than 250,000 patients, the investigators found this inappropriate co-prescription was occurring at a rate of nearly 45%. These errors were seen across the united states, with clusters of high prevalence in the southern and midwestern states.


Speaking of acetylcholinesterase inhibitors, despite showing beneficial effects on 2-year score changes for multiple questionnaire measures, donepezil failed to make a preventive impact on psychosis development in patients with Parkinson disease.

According to the authors, the findings suggested that APOE4 may be suppressing the antipsychotic effect of the therapy, and that APOE4 carriers may be more likely to have comorbid amyloid burden which causes a cortical dysfunction leading to this suppression.

They noted that physicians should look at the condition of patients and pay attention specifically to detect psychotic symptoms. As systemic inflammation or trigger medications, such as amantadine, dopaminergic antagonists, or anticholinergic drugs can cause psychosis, checking for these factors at the presentation of hallucinations is paramount.


Parkinson disease, as many are aware, is a difficult disease to treat, and receiving the diagnosis is not usually easy for patients. However, despite an inability to cure patients, there remains a need to keep their quality of life as high as possible. In a conversation with Dr. Neepa Patel, a movement disorder specialist with the Henry Ford Health System, she mentioned her desire for physicians to keep this in mind. For her, there are still options to help patients have an improved quality of life despite their condition.

She said that she thinks there is still a lot of opportunity in these pretty devastating conditions, and many great symptom-based therapies that can improve the quality of life. She stressed thinking about quality of life as an important part of treating the patient and noted that there are a lot of new therapies that can be used to help them, even though they’re not necessarily helping to change the disease yet.


Dr. Roberto Espay also wants clinicians to think differently about Parkinson—although his hope is that the thought process will evolve into thinking about the condition as the result of many molecular processes occurring over time.


And he noted that in order for the growth of therapies and biomarkers to become truly successful, this altered way of thinking about the disease needs to be addressed. Then, therapies for specific subtypes of the condition can be developed.


In a conversation with Dr. Espay, he explained how this thinking needs to change in order to have truly disease-modifying therapies. Let’s take a look:


For more direct access to expert insight, head to This has been Neurology News Network. Thanks for watching.

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