Entre Sinapses e Políticas: Caminhos para o Cuidado Neurológico no Brasil no Enfrentamento da Doença de Parkinson e das Demências

Abstract

Introduction: neurodegenerative diseases, especially Parkinson’s Disease (PD) and associated dementias, pose a significant challenge to the Brazilian Unified Health System (SUS) due to population aging and the substantial burden of disabilities they generate. Approximately 30% of individuals with PD progress to dementia, worsening functional impairment and increasing the demand for specialized care. Until recently, SUS lacked a specific pharmacological treatment for this condition, revealing an important therapeutic gap and the need to incorporate effective and cost-efficient technologies. Objective: to analyze the incorporation of rivastigmine into SUS for the treatment of dementia associated with PD, assessing its clinical efficacy, safety, cost-effectiveness, and implications for public policies in neurological care. Methodology: this is an analytical-descriptive study based on the CONITEC Recommendation Report No. 902/2024 and scientific articles indexed in databases such as SciELO and Google Scholar. Information was systematized regarding the clinical and epidemiological aspects of PD, evidence on rivastigmine’s efficacy and safety, economic evaluation, budget impact, and current therapeutic guidelines. Analysis and Discussion of Results: the report identified a modest but statistically significant cognitive improvement with rivastigmine: +0.8 points on the MMSE and a 2.1-point reduction on the ADAS-Cog, in contrast to worsening scores in the placebo group. The global clinical assessment (ADCS-CGIC) showed improvement in 40.8% of treated patients versus 29.7% with placebo. Although adverse events were more frequent in the medicated group, the safety profile was deemed acceptable. Cost-effectiveness analysis demonstrated a favorable balance despite the projected budget impact in subsequent years. The final recommendation by CONITEC was unanimous and strongly supported by public consultation. Final Considerations: the incorporation of rivastigmine represents a significant advance in the care of individuals with PD and dementia, addressing a longstanding gap within SUS. However, its full effectiveness depends on strengthening care networks, expanding specialized services, providing rehabilitation strategies, and ensuring continuous monitoring. Robust and intersectoral public policies remain essential to guarantee comprehensive and equitable care in light of the growing prevalence of neurodegenerative diseases in Brazil.