Pharmacological treatment of apathy in Parkinson’s disease, review of the literature

Abstract Background Apathy is a highly challenging factor in the general treatment of patients with Parkinson’s disease (PD) and can present a major burden for caregivers. The objective of this study to answer the question of what is known about the current evidence-based pharmacological treatment of apathy, not combined with comorbid depression or dementia, in PD. Methods We searched for publications in online databases (PubMed, Embase.com, Cochrane Database of Systematic Reviews, CENTRAL and PsycInfo/Ebsco) and performed a review of the literature. Included trials were based on patients with PD, with a drug intervention and apathy as an outcome measurement. Patients with comorbid dementia, severe depression, or patients after deep brain stimulation were excluded. Results Out of 1767 articles, we included 10 articles with a total of 723 patients who received intervention and 311 patients who received placebo, standard care or were healthy controls. Combining the results of the studies with a focus on favourable significant outcomes and the risk of bias, we would advise rivastigmine as a treatment of apathy in patients with PD, and pramipexole or selegiline in PD patients with apathy without cognitive disturbance. An important limitation of this study is that the included studies show a broad heterogeneity. Conclusions Research is sparse on the topic of evidence-based pharmacological treatment for apathy in PD. Combining the results of the studies with a focus on favourable significant outcomes and the risk of bias, we would advise rivastigmine as a treatment of apathy in patients with PD, and pramipexole or selegiline in PD patients with apathy without cognitive disturbance.