title: From high doses of oral rivastigmine to transdermal rivastigmine patches: user experience and satisfaction among caregivers of patients with mild to moderate Alzheimer disease.
abstract: BACKGROUND
  Rivastigmine, a treatment for mild to moderate Alzheimer disease (AD), is the first cholinesterase inhibitor to be available in the transdermal format. We aim to describe user experience and satisfaction with the rivastigmine patch, as well as any clinical changes perceived in patients.
  
  
  METHODS
  Observational, cross-sectional, multicentre study with 239 investigators and 1851 informal caregivers of patients with mild to moderate AD. Patients were treated with transdermal rivastigmine patches for ≥ 6 months and had previously received high doses of oral rivastigmine.
  
  
  RESULTS
  Mean caregiver age was 59.8±14.4 years and 70.9% were women. They spent 10.0±7.1hours per day providing care and 79.8% lived with the patient. Patch instructions were described as easy to follow by 97.1% of the caregivers and 92.1% of them rated patch application as easy or very easy. The most commonly cited disadvantage was adhesion problems (26.8%). Discontinuation of treatment was due to cutaneous reactions in most cases. Overall, 76.5% of the caregivers were satisfied or very satisfied with transdermal treatment and 77.4% considered that its interference with daily activities was minimal or null. The patch was preferred to oral treatment by 94.3% of caregivers. Clinical Global Impression of Change ratings improved according to 61.3% of the caregivers and 53% of the investigators. Few caregivers reported medication forgetfulness.
  
  
  CONCLUSIONS
  Most caregivers of patients with mild to moderate AD preferred the transdermal format of rivastigmine to the oral format. Caregivers also reported overall satisfaction, ease of use, and reduced impact on daily activities for transdermal rivastigmine format, in addition to patient improvement compared to their condition under the previous treatment.
authors.affiliation: Unidad de Diagnóstico y Tratamiento de las Demencias, Servicio de Neurología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. Electronic address: udtd@bellvitgehospital.cat.
authors.forename: R
authors.initials: R
authors.lastname: Reñé
authors.affiliation: Departamento Médico, Novartis Farmacéutica, S.A., Barcelona, España.
authors.forename: J
authors.initials: J
authors.lastname: Ricart
authors.affiliation: Departamento Médico, Novartis Farmacéutica, S.A., Barcelona, España.
authors.forename: B
authors.initials: B
authors.lastname: Hernández
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy*; D017028:Caregivers; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017060:Patient Satisfaction; D048448:Phenylcarbamates / Q000008:administration & dosage / Q000627:therapeutic use*; D000068836:Rivastigmine; D057968:Transdermal Patch
chemical_list: D002800:Cholinesterase Inhibitors; D018696:Neuroprotective Agents; D048448:Phenylcarbamates; D000068836:Rivastigmine
keywords: Alzheimer disease; Clinical Global Impression of Change; Cuidador informal; Cumplimiento terapéutico; Enfermedad de Alzheimer; Impresión Clínica Global de Cambio; Informal caregiver; Parche transdérmico; Rivastigmina; Rivastigmine; Satisfacción; Satisfaction; Transdermal patch; Treatment compliance