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August 01, 2023
Donepezil Transdermal System (Adlarity®): The First Once-Weekly Patch Approved for Treatment of Mild, Moderate, and Severe Alzheimer’s Dementia Donepezil (Adlarity®) is the second transdermal system (TDS) approved in the U.S. for treatment of Alzheimer’s dementia of mild, moderate, and severe types in adults. In comparison to the donepezil oral formulation, the donepezil TDS had shown overall clinical benefit in cognition in Alzheimer’s dementia patients with less incidence of adverse events aside from application site reactions. With less frequent administration and improved pharmacokinetics, this donepezil formulation provides easier adherence for patients who are unable to tolerate the oral formulation known for gastrointestinal events.
Upon completion of the chapter, the reader will be able to:
Describe the epidemiology of Alzheimer disease (AD) and its effects on society.
Describe the pathophysiology, including genetic and environmental factors that may be associated with AD.
Detail the clinical presentation of the typical patient with AD.
Describe the clinical course of the disease and typical patient outcomes.
Explain how nonpharmacologic therapy is combined with pharmacologic therapy for patients with AD.
Recognize and recommend treatment options for disease-specific symptoms as well as behavioral/noncognitive symptoms associated with AD.
Educate patients and/or caregivers about the expected outcomes for patients with AD and provide contact information for support/advocacy agencies.
Alzheimer disease (AD) is characterized by progressive cognitive decline, including memory loss, disorientation, and impaired judgment and learning. There is no single symptom unique to AD; therefore, diagnosis typically relies on a thorough patient history. The exact pathophysiologic mechanism underlying AD is not entirely known, although certain genetic and environmental factors may be associated with the disease. There is no cure for AD; however, drug treatment can slow symptom progression.
Family members of AD patients can be profoundly affected by the increased dependence of their loved ones as the disease progresses. Advocacy organizations, such as the Alzheimer’s Association, can provide early education and social support for both the patient and family. The Alzheimer’s Association has developed a list of common warning signs, which include memory loss, difficulty completing familiar tasks, disorientation, problems with word finding, misplacing things, impaired judgment, social withdrawal, and changes in mood.1
EPIDEMIOLOGY AND ETIOLOGY
AD is the most common type of dementia, affecting an estimated 5.8 million Americans in 2020.2 Eighty percent are of age 75 or older. Additional classifications of dementia include dementia of the Alzheimer type, vascular dementia, and dementia due to human immunodeficiency virus (HIV) disease, head trauma, Parkinson disease, Huntington disease, Pick disease, or Creutzfeldt–Jakob disease.3 This chapter addresses only Alzheimer-type dementia.
The prevalence of AD increases with age. Three percent of people aged 65 to 74, 17% of people aged ...