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 Comparing Exelon in PDD and AD 
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Comparing Exelon in PDD and AD
This abstract just became available on PubMed. The Turkish researcher reviewed data from Exelon (rivastigmine) clinical trials in PDD and AD. "In conclusion, the magnitude of effect with rivastigmine versus placebo is quantitatively comparable in patients with AD and PD, but the treatment effect tended to be one of stabilization in AD, while in PDD improvements over baseline were seen. In both populations, hallucinations may identify patients who are likely to be more treatment-responsive."
Robin


Journal of Alzheimers Disease. 2007 Jul;11(4):509-19.

Rivastigmine in dementia associated with Parkinson's disease and Alzheimer's disease: similarities and differences.

Emre M, Cummings JL, Lane RM.
Department of Neurology, Istanbul Faculty of Medicine, Istanbul, Turkey.

Parkinson's disease dementia (PDD) and Alzheimer's disease (AD) are both characterized by cognitive abnormalities, neuropsychiatric symptoms, and cholinergic deficits.

We reviewed data from large, placebo-controlled clinical trials conducted with rivastigmine in patients with PDD and AD to evaluate similarities and differences in response to treatment. In placebo groups, AD patients appeared to show more rapid cognitive decline than those with PDD. Treatment effects (rivastigmine versus placebo) on cognitive performance over 6 months were quantitatively similar in both populations, but qualitatively different: in AD, cognitive abilities were stabilized by rivastigmine compared to declines in placebo groups, whereas in PDD symptomatic improvements above baseline drove treatment effects while placebo patients had limited change. On activities of daily living, stabilization (rather than improvement) was observed in both dementia types. A more aggressive course of placebo decline, and greater treatment differences (rivastigmine versus placebo), were seen in sub-populations of both PDD and AD patients with hallucinations at baseline. The safety and adverse event profiles were comparable in the two populations.

In conclusion, the magnitude of effect with rivastigmine versus placebo is quantitatively comparable in patients with AD and PD, but the treatment effect tended to be one of stabilization in AD, while in PDD improvements over baseline were seen. In both populations, hallucinations may identify patients who are likely to be more treatment-responsive.

PubMed ID#: 17656830 (see pubmed.gov)


Tue Nov 06, 2007 10:58 pm
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Joined: Thu Aug 30, 2007 6:15 pm
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Location: Charlotte, NC
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If hallucinations make my husband more treatment responsive he should see good improvement. Not yet, but is on 4.6 patch...anyone out there on the 9.2 yet? PLEASE let me hear from you or any experience you may have. Robin you are so lucky to have your support group out in SF...nothing here, if it were not for this forum I think I would loose it.


Wed Nov 07, 2007 7:00 am
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
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You might list where you are located in your profile. Maybe someone will see that and get a support group going with you!


Wed Nov 07, 2007 11:00 am
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Joined: Thu Aug 30, 2007 6:15 pm
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Location: Charlotte, NC
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I am in North Carolina...I see posts from Wilmington but nothing from Charlotte.


Wed Nov 07, 2007 11:56 am
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Joined: Sat Oct 27, 2007 9:16 pm
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Location: tennessee
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Re PubMed study. The neuropsych test after treatment with aricept for my spouse showed slight improvement in short-term memory which the doctor said proved my husband didn't have Alzheimers. He must agree with study. After a while, cognition started decreasing again and he was recently put on exelon 4.6 patch. Appt today 12:45,( those who feel so led please pray) with psychiatrist to evaluate considerable decline which is simultaneous with that change but also with other medicine changes. I'll let you know what he says about possibility of patch causing decline (remote I think from what I've read.

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Wed Nov 07, 2007 1:36 pm
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Location: Charlotte, NC
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PLEASE let me know what you learn from the doctor regarding the patch. I am curious as to whether he will ramp it up to the next dosage 9.2 or put him back on aricept....I ABSOLUTELY will pray for you.


Wed Nov 07, 2007 3:04 pm
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Joined: Sat Oct 27, 2007 9:16 pm
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Location: tennessee
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Dr. doesn't really think the patch caused the decline, but said let's switch him back to aricept and see if that helps. And for the first time, said he thinks he has lbd. What he did not do is postpone the hip replacement surgery. So thank you for your prayers, and if you will continue 11/12, mon is surgery. I've seen so many lists of what he can't take. Does anyone know of something safe he can take? Like to relax him before surgery, for nausea, for pain. Is there a protocol for that?

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Wed Nov 07, 2007 5:47 pm
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Hi Melinda,
In answer to you question this is what I found and it maybe helpful to you. Pain relief is one of the most difficult problems to manage with LBD
patients. In 1990 the World Health Organization approved an "analgesic
ladder" which recommends the stepwise introduction of stronger
painkillers if the more basic ones are ineffective. The word analgesic
simply means painkiller which is any member of a group of drugs used
to relieve pain and to achieve analgsia, which means the absence of
pain. These guidelines were originally introduced for the management
of pain in cancer, but have found application in all fields of
medicine. The first step is paracetamol or acetaminophen (like Tylenol
or Exedrin). The second step involves the addition of an NSAID (e.g.
ibuprofen, Advil) or a weak opioid (such as codeine). The third step
comprises the addition of a strong opioid (such as morphine, oxycodone
or a fentanyl preparation); if codeine is being taken the opioid
replaces codeine.

This final step is where the problems for LBD patients are the worst.
I am not aware of any opioid or similar narcotic that does not have
the potential to cause problems with LBD patients. Trying to manage
pain and still maintain quality of life is difficult, and in some
cases impossible with an LBD patient in severe pain from a source that
may not curable.

Talk to the doctor about your current and future options with pain
management so that you understand the choices available to the doctor,
and also so the doctor understands your wishes and those of the patient.


Wed Nov 07, 2007 8:03 pm

Joined: Thu Aug 30, 2007 6:15 pm
Posts: 231
Location: Charlotte, NC
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the doc has ramped up the patch to the 9.2...just been ordered today. Will see if that helps. Please keep us posted on the results of surgery and his recovery. Will be thinking about you on Monday.


Thu Nov 08, 2007 7:53 am
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Joined: Sat Oct 27, 2007 9:16 pm
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Location: tennessee
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Thank you all. I just talked to the admission people and gave the medicine changes, and she told me the chart was out because the anesthesioligist was trying to reach our psychiatrist and also that LBD was all over the chart. That was so reassuring, she even said she hadn't heard of it but looked it up. So, the people who will be caring for Carl do care enough to learn enough to know enough to take care of him. I am so grateful. Maybe I can now loosen my tight grip on him and release him to their care.

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Thu Nov 08, 2007 10:55 am
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Joined: Sat Oct 27, 2007 9:16 pm
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Location: tennessee
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Spouse had hip replacement Mon morning. Has a couple of hours on first awakening of sweetness and understanding. Starts going downhill then, and I am having to deal with the fury and anger when I prevent him from getting up etc. In rehab ctr, not enough help. Physically doing fine except incontinent, probably because of catheter use and not being able to get up. Somehow, despite all I knew I didn't expect this. Strange, isn't it. I knew he would have a hard time learning rehab, and I knew he would be more confused initially, but I failed to put the two issues together to predict that I would not be able to handle him. He is very strong, and I am not. He cannot be left alone. He has one daughter who is giving me breaks, and I'm staying every night. I've read posts about some caregivers having to go the nursing home route because they could no longer care for them at home. He's in a very good nursing home, and I still can't care for him. How does it work for the rest of you? Medication, restraints? I'm afraid if he doesn't get better soon, they'll put him in a mental facitility and he won't get the rehab. Thank you.

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Fri Nov 16, 2007 4:13 pm
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