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Atomoxetine for the treatment of executive dysfunction in Parkinson's disease: A pilot open-label study

Authors

  • Laura Marsh MD,

    Corresponding author
    1. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
    2. Department of Neurology and Neurological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
    3. Morris K. Udall Parkinson's Disease Research Center of Excellence at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
    • Johns Hopkins University School of Medicine, 600 N. Wolfe Street- Phipps 300, Baltimore, MD 21287
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  • Kevin Biglan MD, MPH,

    1. Department of Neurology and Neurological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
    Current affiliation:
    1. Department of Neurology, University of Rochester Medical School, Rochester, NY, USA
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  • Melissa Gerstenhaber MAS, MSN,

    1. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
    2. Morris K. Udall Parkinson's Disease Research Center of Excellence at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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  • James R. Williams MHS

    1. Morris K. Udall Parkinson's Disease Research Center of Excellence at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
    2. Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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  • Potential conflict of interest: These data were obtained as part of an investigator-Initiated Trial Program research grant from Eli Lilly, Inc. to Dr. Laura Marsh. The authors have complied with all rules regarding the Movement Disorder Society's policy on ghostwriting.

Abstract

Executive dysfunction (ED) is a prominent and often disabling feature of cognitive impairment in Parkinson's disease (PD). Few studies have examined treatments. Given the role of noradrenergic pathology in ED, atomoxetine, a norepinephrine reuptake inhibitor indicated for attention deficit hyperactivity disorder (ADHD), may be a potential treatment for PD-related ED. Twelve patients with PD and disabling ED completed an 8-week pilot open-label, flexible dose (25–100 mg/day) trial of atomoxetine. On primary outcome measures, atomoxetine was associated with improved ED based on the Clinical Global Impression-Change Scale (75% positive response rate; 95% CI: 43–95%, P < 05) and behavioral measures of ED [Frontal Systems Behavior Scale (FrSBE) Executive Dysfunction and Connors Adult ADHD Rating Scale (CAARS) inattention/memory subscales]. Adverse effects included sleep and gastrointestinal disturbances and hypomania. Atomoxetine is tolerable in PD and may benefit clinical manifestations of ED, warranting further study in controlled trials. © 2008 Movement Disorder Society

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