Cholinesterase inhibitors may play an important role in controlling neuropsychiatric and behavioral disturbances in patients, i.e. depression, anxiety, disinhibition and agitation [13]. The midbrain mesencephalic locomotor region (MLR), comprising the pedunculopontine (PPN) and cuneiform nuclei (CN) [14], has recently been highlighted as an important region with respect to gait and balance disorders [15, 16]. On the basis Capmatinib manufacturer of these data, together with the fact that specific lesions of the cholinergic PPN neurons in monkeys induce gait and postural deficits [17], we hypothesized that cholinergic deficit may contribute to the gait and balance

disorders presented by HLGD patients, and that cholinesterase inhibitors could improve balance and reduce falls in subjects

with HLGD. 2 Methods 2.1 Subjects Twenty consecutive consenting Selleckchem XMU-MP-1 patients with HLGD (14 women, age range 69–89 years, mean 79.6 ± 6.1 years) who attended our Movement Disorders Unit were originally enrolled in this pre-post intervention study. These patients were diagnosed as having HLGD by three movement disorders specialists (NG, TG and DM) using criteria described previously [2]. Any other causes for their gait difficulties were excluded in the clinical evaluation. All 20 subjects were able to walk independently for at least 30 m. Those who were on a stable dose of other medications for at least 1 month prior to the baseline assessment buy C646 agreed not to change their medications during the 16 weeks Adenosine triphosphate of the current study. Patients diagnosed as having dementia according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM–IV) criteria and Mini-Mental State Examination (MMSE) scores less than 26 were excluded, as were those with clinically significant depression, orthopedic problems and any other neurological abnormalities

that could have had an effect on gait and postural responses. Patients with a history of severe head trauma or stroke and those with significant structural brain lesions on computerized tomography or with clinically significant orthostatic hypotension were also excluded. In addition, we excluded patients with active malignancy, uncontrolled symptomatic heart disease, diabetes mellitus or hypertension, as well as those with psychiatric disorders. All of the enrolled patients had normal vitamin B12, folic acid, as well as general hematology, electrolytes, renal and liver function tests, and a negative venereal disease research laboratory (VDRL) test. The study was approved by the Ethics Committee of the Tel Aviv Medical Center, and each patient signed an informed consent form prior to enrolling in the study. 2.2 Drug Escalation Rivastigmine was given orally at an initial dose of 1.5 mg twice daily.