Abstract
Background: Prior studies report that monoamine oxidases inhibitors (MAO-I) when used as an adjunct to levodopa ameliorate motor symptoms in Parkinson’s disease (PD), but this was not tested in relation to cognitive or psychiatric measures.Objective: Here, we tested the effects of MAO-I as an adjunct to levodopa, in comparison to levodopa or dopamine (DA) agonists alone, on various cognitive, affective and quality of life measures.Methods: We studied three groups of subjects: healthy controls, PD patients on combined levodopa and MAO-I, and PD patients on levodopa or DA agonists only.Results: We found that compared to monotherapy, combined MAO-I and levodopa seemed to improve cognition, including probabilistic learning, working memory and executive functions. There were no differences between the different medication regimes on deterministic learning, attention or memory recall. It was also found that MAO-I as an adjunct to levodopa improves affective measures such as depression, apathy, anxiety and quality of life. Interestingly, this enhancing effect of combined levodopa and MAO-I was more pronounced in PD patients with severe akinesia, compared to patients with severe tremor.Conclusion: Our data are in agreement with (a) the Continuous Dopaminergic Stimulation (CDS) theory which states that continuous stimulation of the basal ganglia enhances motor, psychiatric and cognitive functions in PD patients; and/or (b) findings that MAO-I increase the bioavailability of monoamines that have beneficial effects on motor and behavioral dysfunction in PD.
Highlights
PHARMACOLOGICAL THERAPY FOR PARKINSON’S DISEASE Parkinson’s disease (PD) is a progressive and neurodegenerative movement disorder associated with a substantial loss of dopamine (DA) neurons in the substantia nigra (Kish et al, 1988), which are essential for regulating the function of the striatum, and the control of voluntary movement
The patients diagnosed by a neurologist as having idiopathic PD according to UK Brain Bank diagnostic criteria for PD and they were in three different treatment regimes such as: (1) a monotherapy of levodopa; (2) monotherapy of DA agonists; and (3) combined therapy of levodopa and MAO- I
Our results extend these findings by showing that MAO-B inhibitors as an adjunct to levodopa have a better effect on cognitive function in PD patients than levodopa or DA agonists monotherapy
Summary
Standard pharmacological medications for PD include levodopa, various kinds of DA agonists, and Monoamine Oxidases Inhibitors (MAO-I), among others. These medications are prescribed as either monotherapy (taken alone) or polytherapy (using more than one medication in combination) (Rinne, 1987). MAO-B inhibitors are often administered in the earlier stages of PD, including selegiline and rasagiline. Both these drugs are used either as monotherapy or in combination with levodopa (Caslake et al, 2009; Riederer and Laux, 2011; Fabbrini et al, 2012). Prior studies report that monoamine oxidases inhibitors (MAO-I) when used as an adjunct to levodopa ameliorate motor symptoms in Parkinson’s disease (PD), but this was not tested in relation to cognitive or psychiatric measures
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