Transdermal Rivastigmine Treatment Does Not Worsen Impaired Performance of Complex Motions in Patients with Alzheimer’s Disease

Abstract

Our study shows an impaired carrying out of complex motion series during neurodegeneration associated with cognitive dysfunction. Rivastigmine selectively inhibits the predominant cortical and hippocampal G1 cholinesterase isoform; therefore, hypothetically no deterioration of fine motor behavior appeared during transdermal rivastigmine treatment. We assume that a putative drug-induced increase in speed and attention did not offset a deterioration of motion performance because we found no significant changes in the CRT results.

Investigating the associations between upper limb motor function and cognitive impairment: a scoping review

“…Tapping index fingers to thumbs at a fast pace for 10 s 2. Fast-paced supination/pronation of the dominant hand for 10 s Number of correct cycles completed Goldman (1999) [ 29 ] Both hands, dominant hand first FT (index-target tapping) An electronic device which is not specified Tapping index finger for 10 s in 3 positions for each hand: wrist and elbow restrained, elbow restrained, and no restraint Number of taps Schroter (2003) [ 30 ] Dominant and non-dominant hand Writing Digitising tablet and a pressure-sensitive inking stylus Drawing concentric circles on a digitising tablet as fast as possible for 30 s, then repeating the task while performing an additional distraction task with the nondominant hand for 10 s Peak velocity SD of velocity Number of changes in direction Amieva (2004) [ 31 ] Not specified FT (index-target tapping) Computer keyboard No details provided Speed Muhlack (2006) [ 32 ] Both hands separately (dominant hand first) PPT 25-hole computer-based contact pegboard Transferring pegs from a rack into one of 25 holes in the board individually and as quickly as possible Time taken to complete the task for each hand Total time Bramell-Risberg (2010) [42 Both forearms Forearm, supination/pronation An optical shaft encoder (Hewlett Packard HEDS5701-A00) connected to a microcontroller (Microchip PIC 16C84) sending the data to the computer Supinating and pronating each forearm separately for 10 s while gripping the handle of the shaft and bend their elbow approximately 90° Number of supination/ pronation Speed Buracchio (2010) [ 6 ] Both hands (index fingers) FT (index-target tapping) …”

“…The PPT involves placing a series of pegs into holes on a board as fast as possible and has been utilised in four studies. Three used the 25-hole PPT [ 19 , 32 , 71 ] and one used a 9-hole pegboard [ 43 ]. Studies used various protocols: two measured the number of pegs inserted into holes of a 25-hole pegboard in 30 s [ 19 , 71 ] and two timed participants inserting pegs and removing them from a 25-hole pegboard [ 32 ] and a 9-hole pegboard respectively [ 43 ].…”

Rivastigmine Transdermal Patch 13.3 mg/24 h: A Review of Its Use in the Management of Mild to Moderate Alzheimer’s Dementia

“…The selectivity of rivastigmine for the G1 isoform (of AChE and BuChE) also means that it is likely to increase ACh levels in the frontal cortex (where G1 occurs at levels of up to 38 %), but not in the caudate nucleus (where G1 occurs at levels of less than 5 %), thereby reducing the risk of movement disorders or tremors associated with an increase in ACh levels in the latter [20]. In a 6-week study [23], once-daily application of transdermal patches loaded with rivastigmine 18-36 mg was not associated with impairment of complex movement performance in patients with AD, probably because of the selectivity of rivastigmine for the G1 isoform of AChE.…”

Rivastigmine in the treatment of patients with Alzheimer's disease

“…It also provides visual reassurance for the caregiver that the medication has been taken. At the same time, possible skin irritation and the presence of a new or unknown object on their body may be confusing or annoying to the person with Alzheimer’s, so a skin patch may not work for everyone (Muhlack et al 2006; Priano et al 2006). The IDEAL (Investigation of TransDermal Exelon in ALzheimer’s disease) was a 24-week, multi-center, randomized, double-blind, placebo- and active-controlled evaluation of once-daily rivastigmine patches versus twice-daily capsules in 1195 patients with moderate stage Alzheimer’s.…”

“…However, further future trials with enrolment of more participants, serial evaluation, and better clinical characterization of the cognitive deficit are needed to address this issue in dementia-related processes. However, no deterioration of complex motion performance was found during this transdermal rivastigmine application in AD (Muhlack et al 2006). This finding is of interest, since there is a controversial debate on onset of extrapyramidal symptoms during cholinesterase inhibition in AD patients or patients with parkinsonism in dementia with lewy bodies (Heinze et al 2002; Richard et al 2002; Hegerl et al 2003; Di Lazarro et al 2004).…”