Rivastigmine for Behavioural Symptoms in Parkinson's Disease: Evidence and Open Questions

Behavioural symptoms, including hallucinations, apathy, and depression, are frequent in Parkinson's disease (PD). This review evaluated the effectiveness of rivastigmine in treating neuropsychiatric symptoms in PD.

A search of PubMed, MEDLINE and EBSCO (1 January 2000-1 October 2025) using terms related to PD and intervention (rivastigmine, anticholinesterase) was conducted. Case reports and case series were excluded.

Eight studies (5 randomized controlled trials and three open-label studies) were selected. Due to the heterogeneity of the outcomes and methodological differences between studies, findings were summarized in a narrative way. In almost all studies, rivastigmine improved hallucinations. Data on the effect of apathy are mixed.

The present review suggests that rivastigmine may improve hallucinations in selected PD patients. Future multicentre, adequately powered randomized controlled trials with a stratification by cognitive status, formulation, and dose of rivastigmine are needed. Despite the limited number of high-quality studies and methodological heterogeneity, clinical practice consistently suggests the beneficial role of rivastigmine in managing behavioural disturbances in PD. In real-world settings, rivastigmine is frequently associated with improvement of hallucinations and affective symptoms, particularly in individuals with co-occurring cognitive impairment. While these observations cannot substitute for robust controlled evidence, they provide additional support for the therapeutic value of rivastigmine.