Efficacy of rivastigmine transdermal therapy on low food intake in patients with Alzheimer's disease: The Attitude Towards Food Consumption in Alzheimer's Disease Patients Revive with Rivastigmine Effects study

Abstract

AimMost patients with Alzheimer's disease (AD) experience poor food intake and/or loss of appetite, which accelerates cognitive impairment. Several reports have shown that rivastigmine improves appetite in AD patients. The present study investigated the efficacy of a rivastigmine transdermal patch for the treatment of low food intake in AD patients.MethodsAD patients, recruited through the Attitude Towards Food Consumption in Alzheimer's Disease Patients Revive with Rivastigmine Effects study, were recognized as experiencing either a loss of appetite or poor food intake. A rivastigmine transdermal patch was administered to study participants for 16 weeks. Patients’ food intake, bodyweight, Mini‐Mental State Examination scores and any adverse events were recorded.ResultsA total of 38 patients with AD (age 86.2 ± 5.4 years) were examined. Their mean Mini‐Mental State Examination score was 10.1 ± 7.0 at baseline. A significant increase in food intake amount (54.9 ± 98.0 g, P < 0.01) and food intake ratio (9.3% ± 17.6%, P < 0.01) was observed by week 1, improvements that were maintained throughout the study duration. A multiple linear regression analysis showed that no independent variables were significantly associated with changes in food intake amount or ratio. Patients in the higher Mini‐Mental State Examination subgroup showed a trend change in food intake amount, although this did not reach statistical significance (P = 0.07).ConclusionsThe present study suggests that a rivastigmine transdermal patch might improve poor food intake or loss of appetite in patients with AD. Geriatr Gerontol Int 2019; 19: 571–576.

Effect of clinical pharmacists' interventions on dementia treatment adherence and caregivers' knowledge

“…25 In our study, local skin reactions were the most common (10.6%) adverse effect declared by patients and caregivers. Similar to in other studies, 26,27 gastrointestinal adverse effects were reported less frequently in our study, as patch usage was more common in these patients.…”

Structure and therapeutic uses of butyrylcholinesterase: Application in detoxification, Alzheimer's disease, and fat metabolism

“…It is noteworthy that they also applied selective AChE inhibitor donepezil orally, but no significant differences were observed in appetite score and levels of plasma cortisol. Other authors ascribed it to the enhanced levels of plasma ghrelin, which might be a result of inhibiting BChE and the improvement of smell and taste perception through cholinergic pathways 240 . Unexpectedly, in 2018, Yoshino et al 243 observed significant decreased levels of plasma ghrelin after application of rivastigmine or donepezil, while they did not record changes of appetite or amount of food intake.…”

“…The Neuropsychiatric Inventory disclosed 12 neuropsychiatric symptoms common in AD patients, including appetite and eating abnormalities 238 . Loss of appetite and behavioral eating disorders could be observed in more than 80% AD patients, ranging from mild to severe, which exerted a great influence on treating and nursing care 239,240 . In 2019, Ishii et al 237 pointed out the relationship between early weight loss of AD patients and the arcuate neuropeptide Y neurons, the latter of which was related to food‐intake.…”

“…Appetite score were calculated based on the survey performed on patients to evaluate their appetite. Some researchers calculated the appetite score of AD patients after the administration of rivastigmine patch, and they found that the score was significantly increased 240,242 . Some authors analyzed that the possible mechanism might be increased cortisol, which was also an effective appetite stimulant contributing to the inhibition of ChE.…”

Acetylcholinesterase Inhibitors in the Treatment of Neurodegenerative Diseases and the Role of Acetylcholinesterase in their Pathogenesis

“…The drug in this form has fewer side effects. One of them is itching of the skin, as well as erythema [214][215][216]. In addition, rivastigmine reduces βA levels, has neuroprotective effects and modifies the APP processing pathway toward the non-amyloidogenic pathway.…”