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Yuan-han Yang - One of the best experts on this subject based on the ideXlab platform.
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skinfold thickness for Rivastigmine patch application in alzheimer s disease
Psychopharmacology, 2019Co-Authors: Ping-song Chou, Kai-ming Jhang, Ling-chun Huang, Wen-fu Wang, Yuan-han YangAbstract:Rivastigmine patches are used for patients with Alzheimer’s disease (AD), but little is known about the serum concentration of Rivastigmine and its metabolite or clinical adherence in relation to skinfold thickness after Rivastigmine patch application. The aim of this study was to examine the association between Rivastigmine and NAP 226-90 serum concentration and skinfold thickness and to determine the appropriate skinfold thickness for the use of Rivastigmine patch in patients with AD. Patients with AD who continuously used Rivastigmine patches (4.6 mg/24 h, 5 cm2) for more than 6 months were recruited. The serum concentrations of Rivastigmine and NAP 226-90 were measured. Skinfold thickness was measured using a Lange Skinfold Caliper. In total, 91 patients with AD (40 men and 51 women) participated in this study on skinfold thickness measurement. Among them, 27 patients were examined for Rivastigmine and NAP 226-90 serum concentrations, with mean concentrations of 1.0 ± 0.6 ng/mL and 3.6 ± 3.6 ng/mL, respectively. The skinfold thickness in the subscapular area was significantly negatively correlated with the NAP 226-90 serum concentration (Spearman’s rank correlation coefficient = − 0.47, P = .01). In addition, patients with AD and a subscapular skinfold thickness of ≥25 mm exhibited a significantly high risk of decreased Mini-Mental Status Examination score and nonadherence to a Rivastigmine patch (odds ratio 3.00; 95% confidence interval = 1.076–8.366, P = .03). Subscapular skinfold thickness was significantly negatively correlated with the NAP 226-90 serum concentration and may be considered an appropriate predictor of response and adherence to clinical application of a Rivastigmine patch.
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Skinfold thickness for Rivastigmine patch application in Alzheimer’s disease
Psychopharmacology, 2019Co-Authors: Ping-song Chou, Kai-ming Jhang, Ling-chun Huang, Wen-fu Wang, Yuan-han YangAbstract:Rivastigmine patches are used for patients with Alzheimer’s disease (AD), but little is known about the serum concentration of Rivastigmine and its metabolite or clinical adherence in relation to skinfold thickness after Rivastigmine patch application. The aim of this study was to examine the association between Rivastigmine and NAP 226-90 serum concentration and skinfold thickness and to determine the appropriate skinfold thickness for the use of Rivastigmine patch in patients with AD. Patients with AD who continuously used Rivastigmine patches (4.6 mg/24 h, 5 cm2) for more than 6 months were recruited. The serum concentrations of Rivastigmine and NAP 226-90 were measured. Skinfold thickness was measured using a Lange Skinfold Caliper. In total, 91 patients with AD (40 men and 51 women) participated in this study on skinfold thickness measurement. Among them, 27 patients were examined for Rivastigmine and NAP 226-90 serum concentrations, with mean concentrations of 1.0 ± 0.6 ng/mL and 3.6 ± 3.6 ng/mL, respectively. The skinfold thickness in the subscapular area was significantly negatively correlated with the NAP 226-90 serum concentration (Spearman’s rank correlation coefficient = − 0.47, P = .01). In addition, patients with AD and a subscapular skinfold thickness of ≥25 mm exhibited a significantly high risk of decreased Mini-Mental Status Examination score and nonadherence to a Rivastigmine patch (odds ratio 3.00; 95% confidence interval = 1.076–8.366, P = .03). Subscapular skinfold thickness was significantly negatively correlated with the NAP 226-90 serum concentration and may be considered an appropriate predictor of response and adherence to clinical application of a Rivastigmine patch.
Jason T. Olin - One of the best experts on this subject based on the ideXlab platform.
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Efficacy of Rivastigmine transdermal patch on activities of daily living: item responder analyses
International journal of geriatric psychiatry, 2011Co-Authors: Gustavo Alva, George T. Grossberg, Frederick A. Schmitt, Xiangyi Meng, Jason T. OlinAbstract:Objective In Alzheimer's disease (AD), Rivastigmine has demonstrated statistically significant efficacy versus placebo on cognition and activities of daily living (ADL). The aim of this retrospective analysis was to further evaluate the treatment effects of Rivastigmine on individual ADL items. Methods This exploratory analysis focused on the Alzheimer's Disease Cooperative Study Activities of Daily Living (ADCS-ADL) outcome from a large, international, 24-week, controlled trial of Rivastigmine once-daily transdermal patch and twice-daily capsules in AD (CENA713D2320, NCT00099242). Percentages of patients “improving” or “not worsening” on individual ADL items were calculated and changes from baseline with Rivastigmine versus placebo were evaluated. Results Patients received Rivastigmine patch (9.5 mg/24 h; n = 247), capsule (12 mg/day; n = 254), and placebo (n = 281). Statistically significant changes from baseline in composite ADCS-ADL scores in both Rivastigmine treatment groups versus placebo (p
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Dose effects associated with Rivastigmine transdermal patch in patients with mild-to-moderate Alzheimer's disease.
International journal of clinical practice, 2011Co-Authors: George T. Grossberg, Jason T. Olin, Monique Somogyi, Xiangyi MengAbstract:Summary Aim: The cholinesterase inhibitor Rivastigmine is available in both oral and transdermal forms. The efficacy of oral Rivastigmine appears to be dose-dependent. The current analysis investigates the effect of dose on the efficacy of the Rivastigmine transdermal patch. Methods: This was a retrospective analysis of a large, international, 24-week, randomised, placebo- and active-controlled trial (IDEAL, CENA713D2320) of Rivastigmine in patients with mild-to-moderate Alzheimer’s disease (AD). Patients received the 9.5 mg/24 h Rivastigmine patch, the 17.4 mg/24 h Rivastigmine patch, 12 mg/day Rivastigmine capsules or placebo. Changes from baseline at week 24 on the AD Assessment Scale–cognitive subscale (ADAS-cog), AD Cooperative Study–Clinical Global Impression of Change (ADCS-CGIC) and the AD Cooperative Study–Activities of Daily Living (ADCS-ADL) scale were calculated based on the patient’s mode and last prescribed patch dose. The analysis included the 4.6 mg/24 h and 13.3 mg/24 h patch doses, for which efficacy data have not previously been reported. Results: Significant differences (p
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Reviews: Effects of transdermal Rivastigmine on ADAS-cog items in mild-to-moderate Alzheimer's disease.
American journal of Alzheimer's disease and other dementias, 2010Co-Authors: George T. Grossberg, Frederick A. Schmitt, Xiangyi Meng, Sibel Tekin, Jason T. OlinAbstract:Alzheimer’s disease (AD) patients treated with Rivastigmine transdermal patch have shown statistically significant differences versus placebo on the AD Assessment scale-cognitive subscale (ADAS-cog). In this retrospective analysis of a double-blind, placebo- and active-controlled, 24-week clinical trial, the specific effects of Rivastigmine patch on individual ADAS-cog items and cognitive domains (memory, language, and praxis) were explored. The mean baseline to week 24 changes were calculated for each ADAS-cog item and domain in this exploratory, hypothesis-generating analysis. Patients on 9.5 mg/24 h Rivastigmine patch, 17.4 mg/24 h Rivastigmine patch, and 3 to 12 mg/d Rivastigmine capsules showed improvements over placebo on the memory and praxis ADAS-cog subscales. The Rivastigmine patch groups also showed improvements on the language subscale. Significant differences versus placebo were seen on several individual item scores in the Rivastigmine-treated groups. Rivastigmine patch was associated with i...
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effects of oral Rivastigmine on cognitive domains in mild to moderate alzheimer s disease
American Journal of Alzheimers Disease and Other Dementias, 2010Co-Authors: Martin R Farlow, Jason T. Olin, Jeffrey L Cummings, Xiangyi MengAbstract:Rivastigmine has beneficial effects on cognitive functioning in Alzheimer's disease (AD). Effects of cholinesterase inhibitors, particularly Rivastigmine, on AD Assessment Scale-cognitive subscale (ADAS-cog) domains and individual items have rarely been analyzed. Results from 4 randomized, double-blind, placebo-controlled, 26-week Rivastigmine capsule trials in patients with mild-to-moderate AD were pooled and ADAS-cog domains and individual items were evaluated. Data were available from 878, 1053, and 863 patients in the 1 to 4 mg/d, 6 to 12 mg/d, and placebo groups, respectively. Rivastigmine-treated groups were superior to placebo on total ADAS-cog and memory domain scores (P < or = .0001). Rivastigmine 6 to 12 mg/d was also significantly better versus placebo on language (P < .001) and praxis (P < .001); greatest treatment responses were seen on memory items (P < .0001). Although Rivastigmine was associated with dose-dependent improvements in all cognitive domains, largest effects were on memory items. Evaluation of ADAS-cog domain scores provides insight into test items most likely to respond to treatment.
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Rivastigmine transdermal system for the treatment of mild to moderate Alzheimer’s disease
International journal of clinical practice, 2010Co-Authors: George T. Grossberg, Carl H. Sadowsky, Jason T. OlinAbstract:Today patients with mild to moderate Alzhiemer's disease (AD) have a treatment approach choice: oral or transdermal delivery. The aim of this review was to provide a concise, comprehensive overview of the clinically relevant safety, tolerability and efficacy information available for the Rivastigmine transdermal system. Relevant articles were identified through a MEDLINE search of publications in the past 3 years using the terms 'Rivastigmine' and 'transdermal' or 'patch'. Efficacy, safety and tolerability of the Rivastigmine patch vs. placebo were established in a large, international, 24-week, double-blind, randomised clinical trial and subsequent 28-week open-label extension study. Drug exposure with the 9.5 mg/24 h Rivastigmine patch was not significantly different to that provided by an oral capsule dose of 12 mg/day. Most frequently observed adverse events were gastrointestinal. In the primary study, incidences of nausea, vomiting and diarrhoea were: 5%, 3% and 3% respectively in the placebo group; 7%, 6% and 6% in the 9.5 mg/24 h Rivastigmine patch group; and 23%, 17% and 5% in the 12 mg/day capsule group. Most patients experienced no, slight or mild application-site skin reactions. De novo patients or those taking oral Rivastigmine or donepezil may tolerate a switch to Rivastigmine patch. By providing drug exposure that is not significantly different to the highest recommended Rivastigmine capsule dose (12 mg/day), with less fluctuation over 24 h, Rivastigmine patch offers similar efficacy with an improved tolerability profile. The Rivastigmine patch provides a viable treatment option for patients with mild to moderate AD.
Antonio Bava - One of the best experts on this subject based on the ideXlab platform.
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Rivastigmine in vascular dementia.
Expert opinion on pharmacotherapy, 2004Co-Authors: Rita Moretti, Paola Torre, Rodolfo M. Antonello, Giuseppe Cazzato, Antonio BavaAbstract:Patients with vascular dementia (VaD) show cholinergic deficits that may result in characteristic clinical syndromes for different subtypes of the condition. Subcortical VaD is characterised by executive dysfunction and behavioural problems, reflecting deterioration of the frontal lobe. Based on limited open-labelled controlled studies of Rivastigmine in VaD, this article aims to determine whether Rivastigmine, a dual inhibitor of acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE), has any effects on the typical symptoms of subcortical VaD. Long-term Rivastigmine treatment is safe and effective. Improvements in domains that characterise subcortical VaD were observed, indicating that Rivastigmine may have provided targeted treatment in areas of the brain that are particularly affected in this patient population. A large, double-blind study of Rivastigmine in patients with VaD is clearly warranted.
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Rivastigmine in frontotemporal dementia an open label study
Drugs & Aging, 2004Co-Authors: Rita Moretti, Paola Torre, Rodolfo M. Antonello, Tatiana Cattaruzza, G Cazzato, Antonio BavaAbstract:This preliminary open-label study aims to investigate the effects of Rivastigmine, an inhibitor of acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE), in 20 patients diagnosed with frontotemporal dementia (FTD). Study subjects were men and women 60–75 years of age diagnosed with probable FTD. The Rivastigmine group received doses of 3–9 mg/day. The control group included matched patients receiving antipsychotics, benzodiazepines and selegiline (deprenyl). All patients completed a 12-month follow-up period. Rivastigmine treatment was well tolerated. At 12 months, there was a general amelioration of behavioural changes as demonstrated by reductions in Neuropsychiatric Inventory (p < 0.001 vs baseline and control), Behavioral Pathology in Alzheimer’s Disease Rating Scale (p < 0.001 vs baseline and control) and Cornell Scale for Depression in Dementia scores (p < 0.05 vs baseline, p < 0.001 vs control) in the Rivastigmine group. Caregiver burden was reduced, as shown by reduced Relative Stress Scale scores (p < 0.001 vs baseline and control). Mean scores on outcome measures evaluating executive function stabilised in the Rivastigmine group (p < 0.05 vs controls). Rivastigmine did not prevent the disease-related deterioration of cognition as assessed using the Mini-Mental State Examination. In this open-label study, Rivastigmine-treated patients were less behaviourally impaired, and caregiver burden was reduced, at 12 months, compared with baseline. The use of cholinesterase inhibitors in FTD warrants further research.
Gustavo C. Román - One of the best experts on this subject based on the ideXlab platform.
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Rivastigmine for subcortical vascular dementia.
Expert review of neurotherapeutics, 2005Co-Authors: Gustavo C. RománAbstract:Rivastigmine is a second-generation cholinesterase inhibitor with selectivity for the CNS, with capacity to inhibit both acetylcholinesterase and butyrylcholinesterase. Rivastigmine is currently approved for the treatment of mild-to-moderate Alzheimer’s disease. In addition to its effects on cognition and activities of daily living, Rivastigmine appears to be useful in preventing and controlling behavioral and neuropsychiatric manifestations in Alzheimer’s disease and dementia with Lewy bodies. This drug profile could be potentially useful in patients with subcortical vascular dementia who often present these symptoms. Small open-label studies of patients with subcortical vascular dementia showed that Rivastigmine improved attention, executive function, apathy and other behavioral deficits. Rivastigmine appears to be a promising agent in vascular dementia but its effects remain to be established in double-blind, placebo-controlled clinical trials.
Jacqueline Birks - One of the best experts on this subject based on the ideXlab platform.
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Rivastigmine for vascular cognitive impairment
Cochrane Database of Systematic Reviews, 2013Co-Authors: David Craig, Jacqueline BirksAbstract:Background Vascular dementia represents the second most common type of dementia after Alzheimer's disease. In older patients, in particular, the combination of vascular dementia and Alzheimer's disease is common, and is referred to as mixed dementia. The classification of vascular dementia broadly follows three clinico-pathological processes: multi-infarct dementia, single strategic infarct dementia and subcortical dementia. Not all victims fulfil strict criteria for dementia and may be significantly cognitively impaired without memory loss, when the term vascular cognitive impairment (VCI) is more useful. Currently, no established standard treatment for VCI exists. Reductions in acetylcholine and acetyltransferase activity are common to both Alzheimer's disease and VCI, raising the possibility that cholinesterase inhibitors - such as Rivastigmine - which are beneficial in Alzheimer's disease, may also be beneficial for VCI. Objectives To assess the efficacy of Rivastigmine compared with placebo in the treatment of people with vascular cognitive impairment (VCI), vascular dementia or mixed dementia. Search methods We searched ALOIS (the Cochrane Dementia and Cognitive Improvement Group’s Specialized Register) on 12 February 2013 using the terms: Rivastigmine, exelon, "SDZ ENA 713". ALOIS contains records of clinical trials identified from monthly searches of a number of major healthcare databases (The Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS), numerous trial registries and grey literature sources. Selection criteria All unconfounded randomized double-blind trials comparing Rivastigmine with placebo in the treatment of people with VCI, vascular dementia or mixed dementia were eligible for inclusion. Data collection and analysis Two reviewers extracted and assessed data independently, and agreement was reached after discussion. They noted results concerning adverse effects. Main results Three trials, with a total of 800 participants, were identified for inclusion. The participants in one trial did not have dementia, while the other two studies included participants with dementia of different severities. The dose of Rivastigmine was different in each study. No pooling of study results was attempted because of these differences between the studies. One trial included 40 participants with subcortical vascular dementia (age range 40 to 90 years) with a mean mini-mental state examination (MMSE) score of 13.0 and 13.4 in the Rivastigmine and placebo arms, respectively. Treatment over 26 weeks was limited to 3 mg Rivastigmine twice daily, or placebo. No significant difference was found on any outcome measure relevant to cognition, neuropsychiatric symptoms, function or global rating, or in the number of withdrawals before the end of treatment. Another trial included 710 participants with vascular dementia, including subcortical and cortical forms (age range 50 to 85 years). Over 24 weeks, a mean dose of Rivastigmine of 9.4 mg/day was achieved versus placebo. Baseline MMSE was identical for both groups, at 19.1. Statistically significant advantage in cognitive response (but not with global impression of change or non-cognitive measures) was seen with Rivastigmine treatment at 24 weeks (MMSE change from baseline MD 0.6, 95% CI 0.11 to 1.09, P value 0.02; Vascular Dementia Assessment Scale (VaDAS) change from baseline MD -1.3, 95% CI-2.62 to 0.02, P value 0.05 ). Significantly higher rates of vomiting, nausea, diarrhoea and anorexia and withdrawals from treatment were noted in the participants randomized to Rivastigmine compared with placebo (withdrawals Rivastigmine 90/365, placebo 48/345, OR 2.02, 95% CI 1.38 to 2.98) (withdrawals due to an adverse event Rivastigmine 49/365, placebo 19/345, OR 2.66, 95% CI 1.53 to 4.62, P value 0.0005). The third study included 50 participants (age range 48 to 84 years) with mean MMSE scores of 23.7 and 23.9 in the Rivastigmine and placebo arms, respectively. Over a 24-week period, participants labelled as having cognitive impairment but no dementia (CIND) following ischaemic stroke were given up to 4.5 mg Rivastigmine twice daily, or placebo. Primary and secondary outcome measures showed no statistically significant difference when considering neurocognitive abilities, function, neuropsychiatric symptoms and global performance. One participant in the Rivastigmine group and two in the placebo group discontinued their medication because of an adverse effect. Authors' conclusions There is some evidence of benefit of Rivastigmine in VCI from trial data from three studies. However, this conclusion is based on one large study. Rivastigmine is capable of inducing side effects that lead to withdrawal in a significant proportion of patients.
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The Cochrane Library - Rivastigmine for vascular cognitive impairment
The Cochrane database of systematic reviews, 2005Co-Authors: David Craig, Jacqueline BirksAbstract:Background Vascular dementia represents the second most common type of dementia after Alzheimer's disease. In older patients, in particular, the combination of vascular dementia and Alzheimer's disease is common, and is referred to as mixed dementia. The classification of vascular dementia broadly follows three clinico-pathological processes: multi-infarct dementia, single strategic infarct dementia and subcortical dementia. Not all victims fulfil strict criteria for dementia and may be significantly cognitively impaired without memory loss, when the term vascular cognitive impairment (VCI) is more useful. Currently, no established standard treatment for VCI exists. Reductions in acetylcholine and acetyltransferase activity are common to both Alzheimer's disease and VCI, raising the possibility that cholinesterase inhibitors - such as Rivastigmine - which are beneficial in Alzheimer's disease, may also be beneficial for VCI. Objectives To assess the efficacy of Rivastigmine compared with placebo in the treatment of people with vascular cognitive impairment (VCI), vascular dementia or mixed dementia. Search methods We searched ALOIS (the Cochrane Dementia and Cognitive Improvement Group’s Specialized Register) on 12 February 2013 using the terms: Rivastigmine, exelon, "SDZ ENA 713". ALOIS contains records of clinical trials identified from monthly searches of a number of major healthcare databases (The Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS), numerous trial registries and grey literature sources. Selection criteria All unconfounded randomized double-blind trials comparing Rivastigmine with placebo in the treatment of people with VCI, vascular dementia or mixed dementia were eligible for inclusion. Data collection and analysis Two reviewers extracted and assessed data independently, and agreement was reached after discussion. They noted results concerning adverse effects. Main results Three trials, with a total of 800 participants, were identified for inclusion. The participants in one trial did not have dementia, while the other two studies included participants with dementia of different severities. The dose of Rivastigmine was different in each study. No pooling of study results was attempted because of these differences between the studies. One trial included 40 participants with subcortical vascular dementia (age range 40 to 90 years) with a mean mini-mental state examination (MMSE) score of 13.0 and 13.4 in the Rivastigmine and placebo arms, respectively. Treatment over 26 weeks was limited to 3 mg Rivastigmine twice daily, or placebo. No significant difference was found on any outcome measure relevant to cognition, neuropsychiatric symptoms, function or global rating, or in the number of withdrawals before the end of treatment. Another trial included 710 participants with vascular dementia, including subcortical and cortical forms (age range 50 to 85 years). Over 24 weeks, a mean dose of Rivastigmine of 9.4 mg/day was achieved versus placebo. Baseline MMSE was identical for both groups, at 19.1. Statistically significant advantage in cognitive response (but not with global impression of change or non-cognitive measures) was seen with Rivastigmine treatment at 24 weeks (MMSE change from baseline MD 0.6, 95% CI 0.11 to 1.09, P value 0.02; Vascular Dementia Assessment Scale (VaDAS) change from baseline MD -1.3, 95% CI-2.62 to 0.02, P value 0.05 ). Significantly higher rates of vomiting, nausea, diarrhoea and anorexia and withdrawals from treatment were noted in the participants randomized to Rivastigmine compared with placebo (withdrawals Rivastigmine 90/365, placebo 48/345, OR 2.02, 95% CI 1.38 to 2.98) (withdrawals due to an adverse event Rivastigmine 49/365, placebo 19/345, OR 2.66, 95% CI 1.53 to 4.62, P value 0.0005). The third study included 50 participants (age range 48 to 84 years) with mean MMSE scores of 23.7 and 23.9 in the Rivastigmine and placebo arms, respectively. Over a 24-week period, participants labelled as having cognitive impairment but no dementia (CIND) following ischaemic stroke were given up to 4.5 mg Rivastigmine twice daily, or placebo. Primary and secondary outcome measures showed no statistically significant difference when considering neurocognitive abilities, function, neuropsychiatric symptoms and global performance. One participant in the Rivastigmine group and two in the placebo group discontinued their medication because of an adverse effect. Authors' conclusions There is some evidence of benefit of Rivastigmine in VCI from trial data from three studies. However, this conclusion is based on one large study. Rivastigmine is capable of inducing side effects that lead to withdrawal in a significant proportion of patients.
