title: Mild cognitive impairment and cognitive impairment, no dementia: Part B, therapy Can elderly people take their medicine? Outcome of Alzheimer's disease: potential impact of cholinesterase inhibitors. Alzheimer’s disease treatment: Assessing caregiver preferences for mode of treatment delivery Caregiver preference for rivastigmine patches versus capsules for the treatment of Alzheimer disease Medicine-taking practices in community-dwelling people aged > or =75 years in New Zealand. Caregiver preference for rivastigmine patch relative to capsules for treatment of probable Alzheimer's disease.
abstract: Mild cognitive impairment ( MCI ) and cognitive impairment , no dementia ( CIND ) might be the optimum stage at which to intervene with preventative therapies . This article review s recent work on the possible treatment and presents evidence ‐based recommendations approved at the meeting of the Third Consensus Conference on the Diagnosis and Treatment of Dementia held in Montreal in March , 2006 . A number of promising nonpharmacologic interventions have been examined . Associations exist with both cognitive and physical activity that suggest that both of these , together or separately , can delay progression to dementia . Similarly , case control studies as well as prospect i ve long‐term studies suggest a number of low toxicity interventions and supplements that might significantly impact on MCI progression ; folate , B6 , and B12 to lower homocysteine levels , omega‐fatty acids , and anti‐oxidants ( fruit juices or red wine ) are good examples . In selected genotypes such as individuals with APOE e4 , therapy with donepezil might slow progression . The concern , however , is that none of these therapies ( including cholinesterase inhibitors ) have demonstrated a clinical ly meaningful effect with r and omized , placebo‐controlled studies . Just as r and omized controlled studies have failed to support primary prevention of dementia by using estrogen or nonsteroidal anti‐inflammatory drugs ( NSAIDs ) , there exists the possibility that well‐ design ed r and omized controlled trials might fail to definitively demonstrate putative or promising mild cognitive impairment interventions .  Pharmacologic interventions and nonpharmacologic therapies , while tantalizing , are currently for the most part insufficiently proven to allow serious consideration by physicians . Recommendation were supported for a general “ healthy lifestyle ” including physical exercise , healthy nutrition , smoking cessation , and mental stimulation . Close monitoring and treatment of vascular risk factors are justified and were also supported This study used performance tests to assess the cognitive , visual and physical abilities related to taking medicines in the elderly population . The study population consisted of the Swedish Panel Study of Living Conditions of the Oldest Old ( SWEOLD II ) , a nationally representative interview survey . SWEOLD II is a r and om sample of all community-based and institutionalized persons aged 77 + in Sweden . Five tests related to medication management were administered in the direct interviews ( n=492 ) : h and function ( opening bottle ) , vision ( reading label ) , and medication competence ( comprehension and calculation ) . Results showed that 9.4 % could not read instructions on a medicine container and 14.6 % had difficulty opening a plastic flip-top medicine bottle . The three cognitive tests related to taking medicine result ed in 30.7 , 47.4 and 20.1 % errors . Combining all the tests revealed that 66.3 % of the sample had at least one limitation of capacity related to taking medicine . There were no significant gender differences . Among those people who did not pass all the tests , 31.8 % lived alone with no home-help . Taking medicines is a complex task and a large proportion of the Swedish elderly population has cognitive , visual or physical limitations that may hinder their ability to take medicines accurately . Awareness of these limitations is essential to concordance BACKGROUND Alzheimer 's disease is fast becoming a major public health concern with serious economic consequences . The cholinesterase inhibitors ( CEIs ) offer some benefit in the symptomatic treatment of the disease . This study aims to investigate the effect of CEIs on three clinical ly relevant domains ( rapid cognitive decline , institutionalization , and weight loss ) in patients with Alzheimer 's disease . METHODS A prospect i ve observational study was performed in which a population of 455 Alzheimer 's disease patients were recruited and followed up for at least 1 year between 1994 and 2002 . Patients were reevaluated at 6 monthly intervals using st and ardized neurocognitive and geriatric evaluations  in addition to complete clinical examination , st and ard para clinical investigations , and recording of treatment received . RESULTS The risk of rapid cognitive deterioration was significantly decreased in patients taking CEIs for at least 1 year compared to untreated patients ( odds ratio [OR]=0.56 , 95 % confidence interval [ CI ] , 0.34 - 0.93 ; p=.025 ) . The potential benefit of CEI use was also found on institutionalization ( OR=0.2 , 95 % CI , 0.08 - 0.48 ; p<.001 ) and weight loss ( OR=0.56 , 95 % CI , 0.32 - 0.97 ; p=.039 ) after 1 year of follow-up . CONCLUSION The special interest of this study is that all patients were recruited and followed in the same center with the same management care plan and the same medical team . This follow-up offers us a unique opportunity to compare the 1-year evolution of the disease in clinical practice before and after the marketing of CEIs and allows us to demonstrate a clinical ly significant improvement in patient outcome over time Introduction Management of patients with Alzheimer ’s Disease ( AD ) can exert a substantial burden upon caregivers . As new modes of treatment administration are developed , it is important to assess caregiver satisfaction and preference in a st and ardized manner . This study describes the development of the Alzheimer ’s Disease Caregiver Preference Question naire ( ADCPQ ) to assess AD caregivers ’ satisfaction with and preference for patch or capsule treatments in AD patients . Methods Twenty-five published articles ( 1987 - 2002 ) were review ed to identify potential ADCPQ domains . Three caregiver focus groups ( n=24 ) were conducted to develop a first draft of the question naire . After evaluating the acceptance of ADCPQ to caregivers through in-depth interviews ( n=10 ) , its psychometric properties were assessed using data from 986 patients enrolled in a multicenter , r and omized , double-blind , four-arm , placebo- and active-controlled , 24-week trial . Results Focus groups indicated that caregivers expressed dissatisfaction with current AD treatment routines including limitations related to : efficacy , administration schedule , number of pills , adherence to treatment , side effects , and taking pills . In-depth interviews with caregivers found the ADCPQ to be comprehensible with an acceptable layout . The result ant ADCPQ comprises three modules : A ) baseline , 11 items assessing treatment expectations ; B ) week 8 , 33 items on satisfaction and preferences with treatment options ; C ) week 24 , 10 items assessing overall opinions of treatment options . Missing data per item was low ( ≤0.3 % ) and domain internal consistency reliability was good ( 0.71–0.91 ) . Preference items were also valid when evaluating concordance and discordance between convenience and satisfaction patch and capsule domain scores . Conclusion AD treatment puts a significant strain on caregivers . New modes of treatment delivery may be less burdensome to caregivers , thereby increasing satisfaction and potential treatment adherence . The ADCPQ was well accepted by AD caregivers and its domains demonstrated satisfactory psychometric properties . The ADCPQ is a useful tool to underst and caregiver preferences for patch versus oral therapies in AD Alzheimer disease ( AD ) has a significant impact on caregivers . Administering and managing medications is one of their many daily tasks . More effective modes of drug administration may benefit patient and caregiver , and may improve compliance . A prospect i ve outcome of the IDEAL ( Investigation of TransDermal Exelon in ALzheimer ’s disease ) trial was to evaluate caregiver preference for rivastigmine patches compared with capsules . The 24-week , r and omized , double-blind , double-dummy , placebo- and active-controlled IDEAL trial investigated once-daily rivastigmine patches vs twice-daily capsules in moderate AD patients . Caregivers rated patch adhesion throughout . The AD Caregiver Preference Question naire ( ADCPQ ) assessed patch vs capsule from caregivers ’ perspective , based on expectations , preferences , and satisfaction with treatment . A total of 1,059 caregivers completed the ADCPQ while their respective patients were on study drug . More than 70 % of caregivers preferred the patch to capsules overall . The patch was preferred to capsules with respect to ease of use ( p < 0.0001 ) and ease of following the schedule ( p < 0.0001 ) . Caregivers indicated greater satisfaction overall ( p < 0.0001 ) and less interference with daily life ( p < 0.01 ) with the patch vs capsules . The preference sub study of the IDEAL trial demonstrated that caregivers of AD patients preferred patches to capsules for drug delivery . Preference for the patch may indicate reduced caregiver stress , substantiated by greater satisfaction and less interference with daily life . These benefits may lead to improved compliance BACKGROUND older people experience more chronic medical conditions than younger people , take more prescription medicines and are more likely to suffer from cognitive or memory problems . Older people are more susceptible to the adverse effects of medicines , which may reduce their quality of life or lead to hospitalisation or death . OBJECTIVE this study aims to identify medicine-taking practice s amongst community-dwelling people aged > or = 75 years in New Zeal and . METHODS this study was carried out in an urban setting in Dunedin ( population 120,000 ) , New Zeal and . Interviews of a r and om sample of people from the electoral roll using a structured question naire were conducted . Subjects were community-dwelling people aged > or = 75 years taking one or more prescription medicines . From a r and om sample of 810 people extracted from the electoral roll intended to recruit 300 participants , 524 people met the study criteria and were invited to participate . People living in a rest home or hospital , not contactable by telephone , or now deceased , were excluded . Responses were analysed , medicines categorised by the Anatomical Therapeutic Chemical classification and adherence classed as high , medium and low using a modified four-item Morisky Medication Adherence Scale . Univariate and multivariate linear and logistic regression was applied to combinations of variables . RESULTS in total , 316 interviews were undertaken ; a 61 % response rate . Participants were 75 - 79 ( 35 % ) , 80 - 84 ( 40 % ) and > 85 years ( 25 % ) ; New Zeal and European/European ( 84 % ) , ' New Zeal and ers ' ( 14 % ) or Maori ( 2 % ) ; and 141 ( 45 % ) lived alone . Almost half ( 49 % ) regularly saw a specialist and a third ( 34 % ) had been admitted to hospital in the past 12 months . Participants used a median of seven prescription medicines ( range 1 - 19 ) and one non-prescription medicine ( 0 - 14 ) . The majority ( 58 % ) believed medicines are effective and had systems/routines ( 92 % ) for remembering to take them . Doses tended to be missed following a change in routine , e.g. holiday . Men were more likely to report ' trouble remembering ' than women ( odds ratio = 1.86 , 95 % confidence interval 1.10 - 3.14 ; P = 0.020 ) . Seventy-five percent of people had high or medium adherence scores and 25 % , low scores . Common problems were reading and underst and ing labels ( 9 and 4 % , respectively ) and leaflets ( 12 % , 6 % ) , and difficulty swallowing solid dose forms ( 14 % ) . Only 6 % had problems paying for their medicines . Around 17 % wanted to know more about their medicines , and some people were confused about their medicines following hospital discharge . CONCLUSION overall , community-dwelling people aged > or = 75 years in this study appeared to manage their medicines well and found them affordable . Nevertheless , there is a need to improve labelling , leaflets and education on medicines , particularly at hospital discharge BACKGROUND Family caregivers comprise a critical component in the care of Alzheimer 's disease ( AD ) patients . Among their many tasks , caregivers are responsible for administering and managing medications . Effective interventions incorporate the needs of both the AD patient and the caregiver , and underst and ing treatment preferences may maximize intervention effectiveness . Transdermal patches may offer advantages over conventional oral formulations . METHODS A 24-week r and omized controlled trial compared the rivastigmine patch to the rivastigmine capsule and placebo in patients with probable AD . At baseline and Weeks 8 and 24 , the AD Caregiver Preference Question naire ( ADCPQ ) was used to evaluate caregiver expectations , preferences and satisfaction with treatment . Double-dummy treatment blinding ensured that caregiver preference for the patch or capsule was not confounded by perceptions of efficacy or tolerability . Reasons for preference were also elicited . The analytic sample included caregivers who completed the ADCPQ at Weeks 8 and /or 24 . RESULTS One thous and and fifty-nine caregivers completed the ADCPQ . More than 70 % of caregivers preferred the rivastigmine patch to the capsule . The patch was significantly preferred to the capsule with respect to ease of following the schedule and ease of use . Caregivers indicated greater satisfaction overall , greater satisfaction with administration , and less interference with daily life with the patch versus the capsule ( all p < or=0.01 ) . CONCLUSION Caregivers of AD patients preferred the patch to the capsule for drug delivery . Preference for the rivastigmine patch could potentially lead to improved compliance and improved clinical benefits
target: Results : Intentional factors affecting adherence include patient , caregiver and prescriber beliefs about therapies and the disease itself .
  Conclusion : Due to the high level of caregiver involvement in the care of patients with AD , strategies that address caregiver concerns may improve adherence
background: Background / Aims : Treatment adherence is a major problem in numerous medical conditions , and is a particular challenge in patients with Alzheimer 's disease ( AD ) .