OBJECTIVES: Motor-related symptoms of patients with Parkinson's disease (PD) are caused by the decrease of dopamine (DA) in the midbrain. Decrease in DA induces imbalance between DA and acetylcholine (ACh), leading to an increase in the relative Ach level, which in turn contributes to motor symptoms again. Therefore, administration of acetylcholinesterase inhibitor (ACHEI), which inhibits the degradation of ACh, to PD patients should be avoided as it may exacerbate the imbalance between DA and Ach. However, a lot of PD patients are using ACHEI for the treatment of cognitive symptoms. Thus, we aimed to analyze the actual use of ACHEI in elderly patients with PD in Korea.

METHODS: PD patients were defined as those having at least one claim record with a diagnosis of PD (ICD-10 codes: G20-21) from 2016 Health Insurance Review and Assessment Service (HIRA) - Adult Patients Sample (APS) data, composed of 20% random sample of patient aged 65 and over in Korea. ACHEI users were defined as those with at least one prescription record of donepezil, rivastigmine or galantamine. Demographic characteristics were compared between ACHEI users and non-users.

RESULTS: Of 24,524 PD patients identified from the 2016 HIRA-APS data, 8,928 patients (36%) were ACHEI users. ACHEI use increased with age (25% in 65-74, 42% in 75-84, and 49% in 85 and over, p <0.0001). The use of ACHEI was more common in women (38%) than men (34%, p <0.0001). Medical Aid beneficiaries (40%) tended to use ACHEI more than National Health Insurance beneficiaries (36%, p <0.0001).

CONCLUSIONS: The use of ACHEI among PD patients in Korea is high. In-depth analysis should be conducted to identify factors affecting ACHEI prescribing in PD patients and to establish effective strategy to avoid potentially inappropriate use of ACHEI at clinical and the national level.