Meagan 10/13/13 English 301 A. Novak Essay #2 Revised for portfolio Alzhei er!

s "isease and the E#elon $at%h Alzhei er!s disease is a forefront topi% of %onversation for today. A%%ording to the Alzhei er!s Asso%iation' Alzhei er!s disease' ore than ( any ho&seholds in A eri%a illion A eri%ans s&ffer fro

aking it the si#th leading %a&se of death in the )nited *tates any ore staggering fig&res are the %ontri.&ting

+Alz.org' 2013,. -hese n& .ers along /ith

reason to /hy resear%h for this disease is %onstantly %ontin&ing and evolving' /ith ne/ edi%ations .eing developed daily. -here are %&rrently ( 0"A approved edi%ations for patients

/ith Alzhei er!s disease' all of /hi%h %over the different stages of de entia and %o e in a generi% for +Alz.org' 2013,. All of these edi%ations are si ilar yet different in s all /ays'

/ith the e#%eption of one1 the E#elon $at%h. -his ne/ pat%h allo/s for the patient to re%eive edi%ation thro&gh a pat%h for ' allo/ing the %aretaker of the patient to think a.o&t one less edi%ation thro&gho&t the day. Many Alzhei er!s edi%ations have to .e taken orally' ho/ever'

this on%e a day appli%ation of the pat%h allo/s for patients to %ontin&o&sly re%eive their edi%ation thro&gho&t the day /ith the E#elon pat%h. 2ith %onsistent Alzhei er!s patients are a.le to perfor edi%ation ad inistration' &%h less

a%tivities of daily living +A"3, /ith

interferen%e. -hese a.ilities in%l&de %ond&%ting everyday a%tivities' %o and

&ni%ation' reasoning

e ory' as /ell. 2hile there is %&rrently no %&re for Alzhei er!s disease' the E#elon pat%h

has proven thro&gh Alzhei er!s patients.

&%h resear%h and develop ent' to .e a forefront

edi%ation for

-his prod&%t %an .e eval&ated .ased on several different %riteria. 4ne %riteria that this prod&%t /ill .e eval&ated &pon is ho/ helpf&l or .enefi%ial it is to the %aregiver. "oes it really help %aregivers ad inister the patients edi%ations5 2o&ld %aregivers prefer to have the edi%ation

edi%ation in an oral for 5 Alzhei er!s disease is very dependent &pon %aregiver!s

ad inistration so this %riteria is very i portant. Another %riteria /o&ld .e the side effe%ts of the edi%ation. 6o&ld the side effe%ts %a&se the patient and %aregiver to %hose to not &se this type of edi%ation over another oral one5 *ide effe%ts are a %o one on reason /hy a patient /o&ld %hose

edi%ation over another' so this %riteria /o&ld .e i portant as /ell. 0inally' /hen all risks edi%ation /o&ld .e the final edi%ation

have .een o&t/eighed' &nderstanding the effe%tiveness of the

%riteria. -his /o&ld need to .e eval&ated d&e to potential %osts and side effe%ts of the to see if it /o&ld .e a Many people %ells %annot %o edi%ation /orthy of taking.

ay not .e infor ed to /hat Alzhei er!s is e#a%tly. 7t o%%&rs /hen .rain &ni%ation' %ognitive a.ilities'

&ni%ate /ith ea%h other %a&sing nor al %o

e ory' and .ehavior to .e affe%ted +Alz.org' 2013,. 7n the .rain' it is the hippo%a p&s that is in %harge of e ory' and /hen Alzhei er!s disease o%%&rs' the .rain %ells of this region are the

first to .e altered or da aged' as stated .y the Alzhei er!s asso%iation +2013,. A%%ording to the 2013 fa%ts and fig&res g&ide fro 83'000 people in 2010. 0ro the Alzhei er!s asso%iation' Alzhei er!s disease killed over

2000 and 2010' Alzhei er!s disease deaths in%reased 98: and

a%%ording to the Alzhei er!s asso%iation' is the only disease in A eri%as top 10 diseases /itho&t a prevention or %&re +Alz.org' 2013,. ;e%a&se there is no %&re for Alzhei er!s' diagnosed patients /ill die /ith the disease and .y 20(0' 19 illion A eri%ans /ill have the disease

+Alz.org' 2013,. 3ike and %aregivers re<&ire

ost diseases' Alzhei er!s has

any different stages. 7nitially' loved ones

ay noti%e that the patient is starting to have tro&.le perfor ing a%tivities that &ltiple

&ltiple steps. An e#a ple of that /o&ld .e follo/ing a re%ipe' or asked to do

things in a %ertain order. Another e#a ple of the first initial signs of the disease /o&ld .e getting lost in a %ity or area that the patient has .een living in or has .een fa iliar /ith for a signifi%ant a o&nt of ti e. Na es' pla%es' dates and appoint ents ay .e%o e a str&ggle to re e .er as

/ell. 2hen the disease .egins to progress' patients have a hard ti e %arrying o&t a%tivities of daily living' or A"3!s. -hese %an in%l&de re e .ering to take a .ath or sho/er' or needing help to get dressed. -heir .ehavior ay %hange drasti%ally' .e%o ing very s&spi%io&s or &pset very ay not .e a.le to ake a fa%e re%ognition to a ore

<&i%kly. At an even f&rther progression' patients loved one or fa ily are the

e .er. As pointed o&t .y E#elonpat%h.%o ' these along /ith several

ost likely sy pto s to noti%e /hen Alzhei er!s disease is progressing. 2ith no /ay to edi%ation to treat the

stop the progression' the only thing that s%ientists and do%tors have is sy pto s. 2ith the rising %osts in

edi%ation and health%are' Alzhei er!s disease is reported to

%ost =1>2 .illion in 2013 in Medi%are and Medi%aid f&nds' only %ontri.&ting to the nations national de.t %risis +Alz.org' 2013,. -he toll is not only .eing taken on the %o&ntry!s e%ono y and de.t %risis' it takes a large toll on the fa ilies affe%ted .y the disease as /ell. -he Alzhei er!s asso%iation +2013, reports that %aregivers and fa ily e .ers have provided 1?.(

.illion ho&rs of &npaid %are in 2012. @&st /hen /e think that a pri%e tag %an!t .e p&t on that %are' it is esti ated that =219.> .illion /as spent in 2012 on the %are of Alzhei er!s and de entia patients that does not get rei .&rsed +Alz.org' 2013,. -hese n& .ers are staggering' and /ill %ontin&e to rise as health%are %osts go &p and the longer /e go /itho&t a %&re or a prevention ethod to stop the disease!s progression. 7f s%ien%e does not progress and the disease %ontin&es

to affe%t

ore people every year' the Alzhei er!s asso%iation +2013, esti ates that .y year 20(0'

Alzhei er!s disease /ill %ost =1.2 trillion in Medi%are and Medi%aid e#penses. -here is already an i ense .&rden on an Alzhei er!s %aregiver fro &ltiple solely the

sy pto s of Alzhei er!s alone' that adding

edi%ations A&st adds to the stress. eaning that it %overs so any different edi%ations ay need to

;e%a&se Alzhei er!s is s&%h a %o prehensive disease'

sy pto s and %a&ses s&%h different effe%ts in ea%h individ&al' different types of ay have to .e &sed to treat ea%h sy pto . All of these %o e in a ta.let for .e taken &p to t/i%e a day. 2hen %o .ined /ith other and

edi%ations that are re<&ired to .e taken

for %onditions s&%h as high .lood press&re or %holesterol' the a.ility to %onstantly re e .er /hi%h edi%ations need to .e taken at /hat ti es of the day %an .e%o e ta#ing on the patient

and on the %aregiver. *in%e E#elon $at%h is only re<&ired to .e applied to the skin on%e a day' that eli inates one edi%ation to /orry a.o&t for the rest of the day. Not to ention /hen the

disease progresses' patients .e%o e less /illing to take

edi%ations' as they .egin to .e%o e edi%ation in a pat%h for

easily agitated and less tr&sting to those aro&nd the ' so having a

re<&ires less stress on the patient' as /ell as the %aregiver. 7n a 2>B/eek rando ized %ontrol st&dy p&.lished in 200? in the 7nternational @o&rnal of Ceriatri% $sy%hiatry' a transder al pat%h' like E#elon pat%h' /as reported to .e the preferred %o&rse of edi%ation /ith ?0: of tested edi%ation'

s&.Ae%ts. -est s&.Ae%ts' or %aregivers of the st&dy' noted to like the si pli%ity of the allo/ing the pat%h to .e /ritten on /ith a .allpoint pen to re ind the

/hen the pat%h /as

originally applied and /hen it needs to .e repla%ed /ith a ne/ one +2in.lad et al.' 200?' p. >89,. *in%e the pat%h only needs to .e applied on%e daily' it /as reported thro&gh this st&dy that the pat%h ade it easier on the %aregivers to sti%k to a daily s%hed&le of edi%ation ro&tine. -he

pat%h only needs to .e pla%ed on the %hest' &pper .a%k' or &pper ar

of the .ody' so sin%e there

is not a spe%ifi% lo%ation that it applying the freedo fro 0or

&st .e pla%ed at' %aregivers and patients have an easier ti e

edi%ation. -he si pli%ity of the E#elon pat%h allo/s for %aregivers to have a the over/hel ing stresses and .&rdens of %aring for an Alzhei er!s patient. ost edi%ations' %o &ni%ating having patientBdo%tor %o &ni%ation a.o&t the the .enefits or

side effe%ts of a

edi%ation is vital to &nderstanding /hat /ill %o e fro edi%ine. Eval&ating a edi%ation

negative aspe%ts of the patients and %aregivers

&st %o e /ith pro!s and %on!s' and edi%ation /ill .e in their .est

&st %on%l&de /hether or not this

interest. A 2>B/eek rando ized trial done .y the 6N* Ne&ros%ien%e and -herape&ti%s 7nstit&tion o&tlined the side effe%ts that they fo&nd /hen testing patients /ith E#elon pat%h +0arlo/ et al.' 2013,. *ide effe%ts /ere different .ased on the strength of the the side effe%ts fo&nd edi%ation. 7n the 13.3 g pat%h'

ost fre<&ently /ere gastrointestinal. -his %o&ld in%l&de na&sea' vo iting &%h raise

and diarrhea +0arlo/' et al.' 2013,. Altho&gh gastrointestinal pro.le s did not %a&se of %on%ern for the >.9

g pat%h in this st&dy' other side effe%ts did %a&se a raise in %on%ern. g pat%h' patients /o&ld e#perien%e agitation'

0arlo/ et al. +2013, indi%ated that on the >.9

&rinary tra%t infe%tions' an#iety' %onf&sion' %onstipation' hall&%inations' and peripheral ede a!s. -he st&dy indi%ated that oneBfo&rth of the patients had e#perien%ed so e kind of skin irritation fro the pat%h on all dosages +0arlo/ et al.' 2013,. Any deaths that had o%%&rred /ere not

%onsidered to .e st&dy related' ho/ever only t/o patients in the trial e#perien%ed /eightBgain as a res&lt of the edi%ation' /hi%h /as %onsidered to .e dr&g related' as stated .y 0arlo/ et al. the %lini%al trial done .y 6N* and +2013, states that the ost

+2013,. 7t is interesting to %o pare the side effe%ts fo&nd fro

those addressed .y the E#elon pat%h /e.site. E#elonpat%h.%o %o

on side effe%ts of the pat%h are1 depression' heada%he' an#iety' dizziness' sto a%h pain' &s%le /eakness' tiredness or tro&.le sleeping. -he E#elon pat%h

&rinary tra%t infe%tions'

/e.site is pro.a.ly re<&ired to %reate a all the different trials of the

ore %o prehensive list of side effe%ts that en%o passes

edi%ation to give %ons& ers a greater idea of /hat %o&ld

potentially happen /hile taking the E#elon pat%h. )nderstanding the side effe%ts of the edi%ation allo/ the patient and %aregiver+s, to patients needs. 3astly' eval&ating the effe%tiveness is /hat deter ines /hether or not this is an appropriate edi%ation for an Alzhei er!s patient. *ohita "hillon +2011, addresses that in ost ake the de%ision if E#elon pat%h is right for the

%lini%al trials of the

edi%ation' the pat%h led to %ognitive i prove ents and attention thro&gh

different tests s&%h as the MiniBMental *tate E#a ination' or MM*E' and the A"3!s s%ores thro&gh the Alzhei er!s disease 6ooperative st&dy. -he pat%h /as noted to have good skin adhesion and not falling off /ith a %hange of %lothing or skin )nless the says that the oist&re +"hillon' 2011' p. D2?,. +2013,

edi%ation has .een left o&t open and e#posed to the air' E#elonpat%h.%o

edi%ation /ill %ontin&e to .e ad inistered thro&gh the transder al pat%h for the

entire 2> ho&rs that it is applied to the skin. ;e%a&se Alzhei er!s disease %annot .e reversed' eas&ring effe%tiveness of the E#elon pat%h %an only .e eval&ated .ased on the progression of the disease thro&gh tests s&%h as the MM*E or the A"3 s%ores. -hese tests %an a%%o&nt for the patients a.ility to sho/ if they have the progressive sy pto s of the disease' allo/ing do%tors to in%rease or add edi%ations to the patients regi ent. edi%ations for a disease like Alzhei er!s re<&ires a signifi%ant a o&nt of

"e%iding on

resear%h and eval&ation of the options that are availa.le. $ersonal preferen%es' side effe%ts' si pli%ity of ad inistration' and overall effe%tiveness are %riteria that help eval&ate not only the E#elon pat%h' .&t sho&ld .e taken into %onsideration /hen %hoosing any type of ne/ dr&g. 2itho&t proper st&dies and res&lts' patients /o&ldn!t have the a.ility to ake the de%isions that

are ne%essary for sele%ting the right pat%h proves that it is a leading

edi%ation for the . -hro&gh the sele%ted %riteria' E#elon

edi%ation in Alzhei er!s disease.

Referen%es Alzhei er!s Asso%iation. +2013,. Retrieved fro 1 ///.alz.org "hillon' *. +2011,. *potlight on rivastig ine transder al pat%h in de entia of the alzhei er!s type. ADIS Spotlight, 28(11), D2?BD30. E#elon $at%h +rivastig ine transder al syste ,. +2013,. Retrieved fro 1 ///.e#elonpat%h.%o 0arlo/' M. R.' Cross.erg' C. -.' *ado/sky' 6. E.' Meng' F.' G *o ogi' M. +2013,. A 2> /eek' rando ized' %ontrolled trial of rivastig ine pat%h 13.3 g/2>h vers&s >.9 g/2>h

in severe alzhei er!s de entia. CNS Neuroscience & Therapeutics, 19, ?>(B ?(2. 0arlo/' M. R.' Miller' M. 3.' G $eAovi%' H. +2008,. -reat ent options in alzhei er!s disease1 Ma#i izing .enefit' anaging e#pe%tations. Dementia an !eriatric Cogniti"e

Disor ers, 2#, >08B>22. 2in.lad' ;.' Ia/ata' A. I.' ;e&sterien' I. M.' -ho as' *. I.' 2i o' A.' 3ane' R. 0ilit' E.' G ;lesa' R. +200?,. 6aregiver preferen%e for rivastig ine pat%h relative to %aps&les for treat ent of pro.a.le alzhei erJs disease. International $ournal o% !eriatric &s'chiatr', 22, >8(B>D1.