title: Efficacy of rivastigmine transdermal patch on activities of daily living: item responder analyses.
abstract: 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 < 0.05) had previously been reported. In this responder analysis of the subset of patients who showed baseline functional impairments on each item, statistically significant differences favoring rivastigmine were seen on the following functions: bathing, clearing dishes, obtaining a beverage, garbage disposal, traveling, shopping, writing, using household appliances, and talking about current events. A responder analysis of emergence of ADL impairment was not as sensitive to treatment effects.
  
  
  CONCLUSIONS
  These findings suggest that rivastigmine may benefit specific ADL, particularly in patients who are already exhibiting functional impairment. Further research is required to improve understanding of how drugs such as rivastigmine exert their clinical effects.
authors.affiliation: ATP Clinical Research, Costa Mesa, CA, USA. galva@theatpgroup.net
authors.forename: Gustavo
authors.initials: G
authors.lastname: Alva
authors.forename: George T
authors.initials: GT
authors.lastname: Grossberg
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Schmitt
authors.forename: Xiangyi
authors.initials: X
authors.lastname: Meng
authors.forename: Jason T
authors.initials: JT
authors.lastname: Olin
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy*; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D048448:Phenylcarbamates / Q000008:administration & dosage / Q000627:therapeutic use*; D011788:Quality of Life; D012189:Retrospective Studies; D000068836:Rivastigmine; D057968:Transdermal Patch
chemical_list: D002800:Cholinesterase Inhibitors; D048448:Phenylcarbamates; D000068836:Rivastigmine