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Alzheimer's Disease & Dementia CE/CME accredited

A relaxed discussion between two faculty focussed on real world clinical issues. Useful tips below will show how to navigate the activity. Join the conversation. Close

Optimizing outcomes for patients with Alzheimer’s disease: A focus on transdermal therapy

  • Downloads including slides are available for this activity in the Toolkit
Learning Objectives

After watching this activity, participants should be better able to:

  • Discuss current barriers to optimal outcomes for patients with Alzheimer’s disease, including the importance of early diagnosis and initiating symptomatic therapies at time of diagnosis
  • Evaluate clinical efficacy and safety data of transdermal and oral cholinesterase inhibitor delivery, and their implications
  • Explain how transdermal options could impact the shared management of Alzheimer’s disease, including day-to-day practical aspects

In this activity, a world-renowned expert in Alzheimer’s disease is joined in conversation by an Alzheimer’s caregiver advocate to address real-world questions on existing barriers to optimal outcomes and the importance of early diagnosis and initiating symptomatic treatment at the time of diagnosis; the clinical implications of available data for transdermal and oral symptomatic therapies; and how transdermal therapies may support shared-management needs in Alzheimer’s disease.

The discussion is guided by pre-canvassed questions provided by healthcare professionals involved in the management of patients with Alzheimer’s disease.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of neurologists, Alzheimer’s disease specialists, geriatricians, specialist nurse practitioners, primary care physicians and pharmacists involved in the management of people living with Alzheimer’s disease.


USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity.  The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.


Prof. George T Grossberg discloses: Consultancy fees from Acadia, Alkahest, Avanir Pharmaceuticals, Axsome, Biogen, Bioxcel Therapeutics, Genentech, Karuna Therapeutics, Lilly, Lundbeck, Otsuka, Roche and Takeda. Research support from Janssen and Roche. Safety monitoring committees for Anavex, EryDel, Intra-Cellular Therapies, Merck and Newron Pharmaceuticals. Speaker’s bureau fees from Acadia and Biogen.

Ms Susan Miller has no interests/relationships or affiliations to disclose in relation to this activity.

Content reviewer

Angela M Hill, PharmD, CRPh has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Directors

Kathy Day has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact



This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Advanced Practice Providers

Physician Assistants may claim a maximum of 1.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.


USF Health is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This knowledge-based program has been approved for 1.0 contact hours (1.0 CEUs). Universal program number is as follows: 0230-0000-22-015-H01-P.

This activity can be viewed on any web browser such as, but not limited to, Google Chrome, Firefox, Safari, Opera, Microsoft Edge and Internet Explorer.

Date of original release: 19 January 2023. Date credits expire: 19 January 2024.

If you have any questions regarding credit please contact


This activity is CE/CME accredited

To obtain contact hours from this activity, please complete this post-activity test.

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  • Downloads including slides are available for this activity in the Toolkit

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Optimizing outcomes for patients with Alzheimer’s disease: A focus on transdermal therapy
1.0 CE/CME credit

Question 1/5
According to available literature, which of the following challenges is a key barrier to the diagnosis of early or mild Alzheimer’s disease in primary care?

AD, Alzheimer’s Disease; MCI, mild cognitive impairment.

Diagnosis of Alzheimer’s disease is particularly challenging in the early phases when patients may have subtle or mild symptoms (e.g. subjective cognitive decline or MCI). In the primary care setting, more than half of patients with cognitive impairment are not recognized or correctly diagnosed; this can result in suboptimal treatment and care, incorrect or delayed treatment initiation and inaccurate prognostic information.


MCI, mild cognitive impairment.


Angioni D, et al. J Prev Alzheimers Dis. 2022;9:569–79.

Question 2/5
Your patient is an 84-year-old female. She has attended the primary care clinic today with her daughter, with whom she has been living for over 10 years. The patient explains that she has been experiencing increasing episodes of forgetfulness, and often not being able to “find the right words”. To explore the possibility of Alzheimer’s disease in this patient, which of the following next steps would you first consider?

APOE4, apolipoprotein E4.

Guidelines emphasize the importance of input from a reliable informant (who knows the patient well) to support objective assessment of changes in cognition, daily living activities and behaviour where Alzheimer’s disease is suspected.1,2 History from a reliable informant should be obtained in the presence of the patient, and with their consent.3 There are a number of informant-based interview tools available that are designed to identify cognitive decline over time.4


  1. McKhann GM, et al. Alzheimers Dement. 2011;7:263–9.
  2. Albert MS, et al. Alzheimers Dement. 2011;7:270–9.
  3. Briggs R, O’Neill D. QJM. 2016;109:301–2.
  4. Taylor-Rowan M, et al. Syst Rev. 2020;9:271.
Question 3/5
Based on the available data, which of the following transdermal patches demonstrated efficacy versus oral therapies in non-inferiority trials?

Non-inferiority trials have compared oral formulation versus transdermal patch for both rivastigmine and donepezil.1,2, Change in ADAS-Cog score from baseline to Week 24 was used as measurement of efficacy.

Compared with placebo, rivastigmine achieved comparable differences in ADAS-Cog in both once-daily 10 cm2 transdermal patch and oral 3–12 mg capsule formulations (mean change in ADAS-Cog score was -0.6; p=0.005 and -0.6; p=0.003 respectively).1 Donepezil once-weekly transdermal patch (25 cm2 and 50 cm2) demonstrated non-inferiority to donepezil oral tablet (mean change in ADAS-Cog score was -0.47 and -0.93; p=0.8975 respectively).2


ADAS-Cog, Alzheimer’s Disease Assessment Scale–Cognitive.


  1. Winblad B, et al. Int J Geriatr Psychiatry. 2007;22:456–67.
  2. Han HJ, et al. J Clin Neurol. 2022;18:428–36.
Question 4/5
Your patient is a 73-year-old male currently receiving treatment with a once-daily donepezil tablet to manage mild Alzheimer’s disease. During your follow-up consultation, he explains he is not always able to take his daily medication as prescribed, as he has so many other tablets and supplements to take and finds it too confusing. Which of the following might you consider next in the management of this patient to reduce daily medication burden?

Choice of treatment with oral or transdermal symptomatic therapy should be based on patient and caregiver preference, ease of use and tolerability.1 The reduced frequency with once-weekly of dosing with transdermal medications in patients who already have a high medication burden could also increase adherence to treatment.2 Once-daily oral galantamine extended-release formulation is indicated in mild and moderate Alzheimer’s disease.3 Once-daily oral donepezil plus memantine extended-release formulation is indicated in moderate to severe Alzheimer’s disease stabilized on 10 mg of donepezil once daily.4


  1. Cummings JL, et al. Ann Clin Transl Neurol. 2015;2:307–23.
  2. Citrome L, et al. J Clin Psychiatry. 2019;80:18nr12554.
  3. FDA. Galantamine PI. 2021.
  4. FDA. Memantine and donepezil PI. 2014.

FDA Prescribing information searchable by agent at (accessed 6 December 2022).

Question 5/5
For patients with severe dementia who have a diminished ability to swallow and become easily agitated when taking their medication, which of the following options would you discuss with care partners to maintain effective treatment and allow care partners to administer reliably?

Donepezil and rivastigmine transdermal patch formulations are both indicated for the management of mild, moderate and severe Alzheimer’s disease.1,2 Transdermal patches are easy to administer and to check for adherence.3 Real-world data show care partner preference for (and greater satisfaction with) transdermal patches compared with oral formulations of symptomatic therapy (rivastigmine) for ease of administration, scheduling and less interference with daily activities.4,5 Patient adherence was reported as significantly higher with transdermal patches compared with oral formulations.5


  1. FDA. Donepezil transdermal system PI. 2022.
  2. FDA. Rivastigmine transdermal system PI. 2018.
  3. Citrome L, et al. J Clin Psychiatry. 2019;80:18nr12554.
  4. Winblad B, et al. Int J Geriatr Psychiatry. 2007;22:485–91.
  5. Pai MC, et al. Clin Interv Aging. 2015;10:1779–87.

FDA Prescribing information searchable by agent at (accessed 6 December 2022).

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