Alzheimer’s disease (AD) is a heterogeneous condition that can be definitively diagnosed only on autopsy1,2. AD is a chronic progressive neurodegenerative disorder characterised by three groups of symptoms: cognitive dysfunction (such as executive dysfunction, language difficulties and memory loss), non-cognitive symptoms (psychiatric symptoms and behavioural disturbances, for example agitation, delusions, depression, hallucinations) and difficulties with performing daily tasks (either basic such as dressing and eating or complex such as driving or shopping). Rapid diagnosis is important, Professor Small argues, therefore recommends starting treatment rapidly. Treatment early in the course of AD helps maintain cognitive and functional performance and delay the emergence of distressing behavioural and psychological symptoms, such as depression, anxiety and apathy3.
Optimal dosing of cholinesterase inhibitors is essential to maximise the improvements while limiting the adverse event burden. For instance, many people taking oral cholinesterase inhibitors fail to achieve the most efficacious blood levels because of adverse events4. Transdermal formulations of cholinesterase inhibitors may overcome these problems. In moderate to severe AD, combinations of drugs with different mechanisms of action seem to improve multiple outcomes in AD5.
Meet the expert
Professor Gary Small is Professor of Psychiatry and Biobehavioural Sciences and Parlow-Solomon Professor on Aging at the David Geffen School of Medicine at UCLA, where he is also Director of the UCLA Longevity Center.
How is Alzheimer’s disease diagnosed?
Treating Alzheimer’s disease
How effective is a rivastigmine patch vs. rivastigmine capsules?
In this video, Professor Small explains why the pharmacological characteristics of rivastigmine allow transdermal delivery, a route of administration that facilitates improved care of AD patients.
Disease and treatment burden
What is the importance of treatment adherence and persistence in patients with AD?
- Perl DP. Neuropathology of Alzheimer’s disease. Mount Sinai Journal of Medicine. 2010;77(1):32–42.
- Devi G, Scheltens P. Heterogeneity of Alzheimer’s disease: Consequence for drug trials? Alzheimer’s Research and Therapy. 2018;10(1):122.
- Steinberg M, Shao H, Zandi P, Lyketsos CG, Welsh-Bohmer KA, Norton MC, et al. Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: The Cache county study. Int J Geriatr Psychiatry. 2008;23(2):170–177.
- Imbimbo B Pietro. Pharmacodynamic-tolerability relationships of cholinesterase inhibitors for Alzheimer’s disease. CNS Drugs. 2001;15(5):375–390.
- Matsunaga S, Kishi T, Iwata N. Combination therapy with cholinesterase inhibitors and memantine for Alzheimer’s disease: a systematic review and meta-analysis. Int J Neuropsychopharmacol. 2014;18(5). doi:10.1093/ijnp/pyu115.
- Scott KR, Barrett AM. Dementia syndromes: Evaluation and treatment. Expert Review of Neurotherapeutics. 2007;7(4):407–422.
- Risacher SL, Saykin AJ. Neuroimaging biomarkers of neurodegenerative diseases and dementia. Semin Neurol. 2013;33(4):386–416.
- Winblad B, Cummings J, Andreasen N, Grossberg G, Onofrj M, Sadowsky C, et al. A six-month double-blind, randomized, placebo-controlled study of a transdermal patch in Alzheimer’s disease - Rivastigmine patch versus capsule. Int J Geriatr Psychiatry. 2007;22(5):456–467.
- Burns A, Iliffe S. Alzheimer’s disease. BMJ (Online). 2009;338(7692):467–471.
- Sheehan B. Assessment scales in dementia. Ther Adv Neurol Disord. 2012;5(6):349–358.
- Hort J, O’Brien JT, Gainotti G, Pirttila T, Popescu BO, Rektorova I, et al. EFNS guidelines for the diagnosis and management of Alzheimer’s disease. European Journal of Neurology. 2010;17(10):1236–1248.
- Sorbi S, Hort J, Erkinjuntti T, Fladby T, Gainotti G, Gurvit H, et al. EFNS-ENS Guidelines on the diagnosis and management of disorders associated with dementia. Eur J Neurol. 2012;19(9):1159–1179.
- Scharre DW, Vekeman F, Lefebvre P, Mody-Patel N, Kahler KH, Duh MS. Use of antipsychotic drugs in patients with Alzheimer’s disease treated with rivastigmine versus donepezil: A retrospective, parallel-cohort, hypothesis-generating study. Drugs and Aging. 2010;27(11):903–913.
- Schmidt R, Hofer E, Bouwman FH, Buerger K, Cordonnier C, Fladby T, et al. EFNS-ENS/EAN Guideline on concomitant use of cholinesterase inhibitors and memantine in moderate to severe Alzheimer’s disease. Eur J Neurol. 2015;22(6):889–98.
- Maxwell CJ, Stock K, Seitz D, Herrmann N. Persistence and adherence with dementia pharmacotherapy: Relevance of patient, provider, and system factors. Can J Psychiatry. 2014;59(12):624–631.
- Molinuevo JL, Arranz FJ. Impact of transdermal drug delivery on treatment adherence in patients with Alzheimer’s disease. Expert Rev Neurother. 2012;12(1):31–37.
The Neuroscience and Pain Learning Zone has been developed by EPG Health for Medthority in collaboration with Novartis Pharma AG, with content provided by Novartis Pharma AG. The views presented in the videos are those of the presenters and not necessarily those of the industry sponsor, Novartis Pharma AG. Neuroscience GLEM/CNS/0026 (March 2020) and Pain GLEM/PAIN/0053 (March 2020).