Recommendation ID

Combination treatment for Parkinson's disease dementia:- What is the effectiveness of combination treatment with a cholinesterase inhibitor and memantine for people with Parkinson's disease dementia if treatment with a cholinesterase inhibitor alone is not effective or no longer effective?

Any explanatory notes
(if applicable)

Why this is important:- The guideline committee felt that cholinesterase inhibitors, memantine and combination therapy with both treatments are all reasonable clinical options, but noted that some people do not tolerate cholinesterase inhibitors well due to side effects. The evidence base for memantine was considerably weaker than for cholinesterase inhibitors, and therefore there would be value in either additional trials of memantine compared with placebo (in people for whom cholinesterase
inhibitors are not an option), or non-inferiority studies compared with cholinesterase inhibitors.
In clinical practice, memantine is often added to a cholinesterase inhibitor when it is no longer proving effective, but there is no evidence base for this and randomised trials to establish whether there is additional benefit would be valuable. Both of these questions could potentially be answered in a single study with 3 arms of memantine monotherapy, cholinesterase inhibitor monotherapy and combination treatment.

Source guidance details

Comes from guidance
Parkinson’s disease in adults
Date issued
July 2017

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 31/07/2017