Efficacy of higher‐dose 13.3 mg/24 h (15 cm2) rivastigmine patch on the Alzheimer's Disease Assessment Scale–cognitive subscale: domain and individual item analysis. (18th February 2014)

• Record Type: Journal Article
• Authors: Alva, Gustavo; Isaacson, Richard; Sadowsky, Carl; Grossberg, George; Meng, Xiangyi; Somogyi, Monique
• Is Part Of: International journal of geriatric psychiatry. Volume 29:Number 9(2014:Sep.)
• Page Start: 920
• Page End: 927
• Publication Date: 2014-02-18
• Subjects: Geriatric psychiatry -- Periodicals; Geriatric Psychiatry -- Periodicals; 618.97689
• DOI: 10.1002/gps.4080
• Languages: English
• ISSNs: 0885-6230

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="gps4080-sec-0001" sec-type="section"> <title>Objective</title> <p>Rivastigmine displays dose‐dependent efficacy on cognition in patients with Alzheimer's disease (AD), as measured by the Alzheimer's Disease Assessment Scale–cognitive subscale (ADAS‐cog). Subanalysis of the OPTIMA (<underline>OP</underline>timising <underline>T</underline>ransdermal Exelon <underline>I</underline>n <underline>M</underline>ild‐to‐moderate <underline>A</underline>lzheimer's disease) study aimed to define ADAS‐cog domains by factor analysis of individual items. Efficacy of 13.3 mg/24 h versus 9.5 mg/24 h rivastigmine patch on individual items and newly derived domains was assessed.</p> </sec> <sec id="gps4080-sec-0002" sec-type="section"> <title>Methods</title> <p>OPTIMA was a 48‐week, double‐blind (DB) study in patients with mild‐to‐moderate AD. Patients meeting pre‐defined decline criteria during open‐label treatment with 9.5 mg/24 h patch were randomized in the DB phase to 13.3 mg/24 h (<italic>n</italic> = 280) or 9.5 mg/24 h (<italic>n</italic> = 287) patch. ADAS‐cog change from baseline was a co‐primary outcome measure. Factor analysis categorized ADAS‐cog items into newly derived domains. Change from DB‐baseline was calculated for domains and individual items.</p> </sec> <sec id="gps4080-sec-0003" sec-type="section"> <title>Results</title> <p>Numerically, less decline was displayed with 13.3 mg/24 h versus 9.5 mg/24 h patch in the total ADAS‐cog score at all time points (significant at Week 24, <italic>p</italic> = 0.027). Factor analysis identified two domains: memory and language. Significantly, less decline was observed on the memory domain with 13.3 mg/24 h versus 9.5 mg/24 h patch at Weeks 12, 24, and 48 (<italic>p</italic> < 0.05; observed cases). Three items (following commands, orientation, and word recognition) displayed numerically less decline with 13.3 mg/24 h versus 9.5 mg/24 h patch at all time points. No significant between‐group differences were observed on the language domain.</p> </sec> <sec id="gps4080-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Results suggest that the greater cognitive efficacy of 13.3 mg/24 h versus 9.5 mg/24 h rivastigmine patch is driven primarily by effects on memory, particularly in the areas of following commands, orientation, and word recognition. Copyright © 2014 John Wiley & Sons, Ltd.</p> </sec> </abstract>