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Original article
From high doses of oral rivastigmine to transdermal rivastigmine patches: user experience and satisfaction among caregivers of patients with mild to moderate Alzheimer disease
Experiencia de uso y satisfacción con rivastigmina transdérmica en cuidadores de pacientes con enfermedad de Alzheimer de leve a moderada previamente tratados con rivastigmina oral a dosis altas
R. Reñéa,
Corresponding author
udtd@bellvitgehospital.cat

Corresponding author.
, J. Ricartb, B. Hernándezb, representing researchers in the Experience study
a Unidad de Diagnóstico y Tratamiento de las Demencias, Servicio de Neurología, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
b Departamento Médico, Novartis Farmacéutica, S.A., Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Treatment for mild to moderate Alzheimer disease &#40;AD&#41; is based on oral acetylcholinesterase inhibitors &#40;AChEI&#41; such as rivastigmine&#44; donepezil&#44; and galantamine&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> These drugs have been shown to exert a dose-dependent beneficial effect on cognitive function&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> However&#44; the incidence of adverse events also increases with the dose&#8212;especially when there is no prior dose adjustment period&#8212;and with the peak plasma concentrations resulting from oral administration&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The first transdermal treatment for AD has now been approved&#58; a rivastigmine patch<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> that continuously releases the drug over the 24<span class="elsevierStyleHsp" style=""></span>hours after application&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Dosed at 9&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#44; this patch has an effect equivalent to that of higher doses of oral rivastigmine&#44; and it is associated with fewer adverse gastrointestinal effects&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> It has also been shown that patients treated with high doses of oral rivastigmine may change directly to the transdermal patch dosed at 9&#46;5<span class="elsevierStyleHsp" style=""></span>ml&#47;day with no need for a prior adjustment period and without experiencing further adverse effects&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Treatment for patients with AD is generally managed by caregivers&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> As a result&#44; their assessment of treatment efficacy and the workload generated by the treatment may have a decisive effect on efforts to improve treatment compliance and ensure that the patient obtains the greatest benefit from the drugs prescribed&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Earlier studies have reported a better user experience&#44; higher satisfaction&#44; and less interference in the carer&#39;s daily activities with transdermal rivastigmine than with oral rivastigmine&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The purpose of our study was to report on user experience with high doses of transdermal rivastigmine among informal caregivers of patients with mild to moderate AD&#46; Likewise&#44; we gathered data about caregiver satisfaction and preferences regarding the transdermal route&#44; any improvements perceived in patients after the change from oral treatment&#44; and treatment adherence&#46; At the same time&#44; we analysed user experience&#44; satisfaction&#44; and any perceived improvements in patients treated transdermally as reported by healthcare professionals treating patients with AD&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This cross-sectional multi-centre observational study was carried out across Spain&#46; During a 6-month period&#44; informal caregivers were recruited consecutively during routine visits to different participating neurology&#44; psychiatry&#44; or geriatric care clinics&#46; Inclusion criteria were as follows&#58; &#40;a&#41; caring for a patient with mild to moderate AD &#40;defined as a score &#8805;10 and &#60;26 on the Mini-Mental State Exam &#91;MMSE&#93;&#41; who was on stable treatment during &#8805;6 months with the highest approved dose of transdermal rivastigmine &#40;9&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; and who previously had received high doses of oral rivastigmine &#40;9&#8211;12<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#59; &#40;b&#41; having cared for the patient for at least 1 year&#59; &#40;c&#41; being responsible for managing the patient&#39;s medications&#44; and &#40;d&#41; being able to provide accurate information about the study variables&#46; We excluded caregivers of patients with severe AD &#40;MMSE<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10&#41; or dementia of other causes&#44; paid caregivers&#44; and those considered by researchers to be unable to participate in the study&#46; The decision to use MMSE rather than other AD assessment scales&#44; and the scoring ranges employed to classify patients as having mild-to-moderate or severe AD&#44; reflect the latest guidelines published by the National Institute for Health and Clinical Experience &#40;NICE&#41; for rivastigmine treatment in AD patients&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">During the same inclusion visit&#44; and after receiving the caregiver&#39;s written informed consent statement&#44; researchers proceeded to take down data&#46; The main variable&#44; the caregiver&#39;s user experience with transdermal rivastigmine&#44; was measured using an ad hoc questionnaire&#46; As secondary variables&#44; researchers recorded the caregiver&#39;s demographic and care arrangement data &#40;including time as patient&#39;s caregiver&#44; daily hours dedicated to care activities&#44; number of daily medications&#44; and time spent preparing and administering treatment&#41;&#46; The researcher&#39;s user experience and the caregiver&#39;s and the researcher&#39;s satisfaction with treatment were documented using ad hoc questionnaires similar to the one used for the main variable&#46; Overall caregiver satisfaction was evaluated quantitatively and qualitatively&#59; caregivers rated satisfaction between 1 &#40;very satisfied&#41; and 5 &#40;very unsatisfied&#41;&#46; Doctor satisfaction&#44; whether overall or satisfaction with patch efficacy and tolerability&#44; was scored from 1 &#40;no satisfaction&#41; to 10 &#40;maximum satisfaction&#41;&#46; Caregiver preference for treatment was evaluated using the question &#8220;What form of rivastigmine treatment do you prefer&#63;&#8221; Caregivers were able to choose between &#8216;oral&#8217; and &#8216;transdermal&#8217;&#46; Improvements in the patient&#44; whether perceived by caregivers or doctors&#44; were evaluated using the Clinical Global Impressions-Change scale &#40;CGI-C&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> This questionnaire consists of a single question comparing the patient&#39;s general states of health under the current and the previous treatments&#46; There are 7 possible responses ranging from &#8216;much better&#8217; to &#8216;much worse&#8217;&#46; Treatment adherence was evaluated using a Morisky adherence scale&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> This questionnaire includes 2 questions to measure forgetfulness and commitment to providing care&#44; and 2 others to determine whether treatment was interrupted at any time and if the respondent understands the long-term benefits of the medication&#46; A single suboptimal answer served to classify the respondent as showing poor adherence&#46; Since this questionnaire was originally designed for use by patients&#44; we adapted it for use by caregivers and to specifically address transdermal rivastigmine treatment&#46; We also added a question to determine the frequency with which caregivers forgot to administer treatment&#46; Researchers followed the Declaration of Helsinki and Good Clinical Practice guidelines at all times&#46; The study was approved by the Clinical Research Ethics Committee at Hospital Universitari de Bellvitge &#40;L&#8217;Hospitalet de Llobregat&#44; Barcelona&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Statistical analysis was completed using SAS statistics software for Windows&#44; version 9&#46;2&#46; The analysis included all carers who met selection criteria and for whom there were valid data for the main variable&#46; Substitution methods were not employed for missing data&#46; Discrete qualitative and quantitative variables were described as absolute frequencies &#40;<span class="elsevierStyleItalic">n</span>&#41; and relative frequencies &#40;percentages&#41;&#46; Continuous quantitative variables were described as the mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation &#40;SD&#41;&#46; The chi-square test was used to assess differences in the CGI-C scale scores given by informal caregivers and doctors&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Population characteristics</span><p id="par0035" class="elsevierStylePara elsevierViewall">The study recruited a total of 1975 informal caregivers&#46; Of these caregivers&#44; 89 were excluded due to not meeting selection criteria&#44; and 35 were excluded because they lacked experience with transdermal rivastigmine&#46; In the end&#44; 1851 caregivers and 239 doctors from 198 centres were included&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the characteristics of both the caregivers and the care they provide&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">User experience</span><p id="par0040" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> displays the most important findings regarding caregivers&#8217; user experience for transdermal rivastigmine&#46; The most common areas for patch application were the chest&#44; arms&#44; and dorsal-lumbar region &#40;data not shown&#41;&#46; Most caregivers &#40;94&#46;7&#37;&#41; reported changing patches daily&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Researchers&#8217; experience is summarised in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; More than half of the patients treated with rivastigmine received it in transdermal form&#46; Most patients in this subgroup remained on the same treatment 6 months after having started it&#46; The majority of the researchers recorded that patients and caregivers preferred transdermal treatment and found it easier to use than the oral form&#46; The main reasons cited by patients for leaving or not beginning transdermal treatment are summarised in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Treatment satisfaction and preferences</span><p id="par0050" class="elsevierStylePara elsevierViewall">Most caregivers and doctors expressed overall satisfaction with transdermal treatment &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Caregivers scored their satisfaction level at 2&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;4 points&#46; Most caregivers rated using the patch as easy or very easy &#40;92&#46;8&#37;&#41; and assigned a similar rating to following the treatment schedule &#40;94&#37;&#41;&#46; However&#44; only 65&#37; rated the patch as easy for patients to apply by themselves&#46; Most caregivers indicated that administering transdermal treatment interfered little or not at all in their daily routine &#40;77&#46;4&#37;&#41; or the patient&#39;s daily routine &#40;78&#46;6&#37;&#41;&#46; Assessment of caregiver preference for rivastigmine routes of delivery showed that this group clearly favoured the transdermal form &#40;94&#46;3&#37;&#41;&#46; Among doctors&#44; 90&#37; had medium-to-high hopes for the rivastigmine patch before beginning to use it&#59; approximately 92&#37; declared that the product delivered the results they had expected&#46; Almost all of the professionals &#40;90&#46;9&#37;&#41; rated the treatment as easy based on the opinions expressed by their patients&#46; Clinical efficacy earned a mean score of 7&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;33 points&#46; Cutaneous tolerability had a mean score of 7&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;48 points&#59; gastrointestinal&#44; 8&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;96&#59; and overall tolerability&#44; 8&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;93&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">CGI-C scale</span><p id="par0055" class="elsevierStylePara elsevierViewall">Caregivers&#8217; and doctors&#8217; opinions on the patient&#39;s state of health under the new treatment compared to the previous treatment are shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#46; In general&#44; both groups considered that patients had remained stable or shown improvement&#44; although informal caregivers perceived significantly greater degrees of improvement than doctors did&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Compliance</span><p id="par0060" class="elsevierStylePara elsevierViewall">Fifty-seven per cent of the caregivers were categorised as compliant&#46; The factor with the greatest impact on treatment compliance was the tendency among caregivers to stop administering the drug if patients experienced adverse events&#46; The forgetfulness rate was low when patients were treated with rivastigmine patches&#46; Results from the adherence questionnaire are shown in <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">The characteristics of the caregivers assessed in this study coincide with those found by another recent study in our region that examined carers of patients treated with AChEI&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Most were women about 60 years of age&#44; with a primary education and actively employed&#46; Roughly 80&#37; shared a household with their patients and spent a mean of 10<span class="elsevierStyleHsp" style=""></span>hours daily caring for them&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Generally speaking&#44; caregivers expressed satisfaction with transdermal treatment and considered that instructions were easy to follow and patches were easy to apply&#46; Concurring with these results&#44; a recent randomised study<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> found that 93&#37; of patients &#40;or their caregivers&#41; who had been receiving high doses of oral rivastigmine and who switched directly to high transdermal doses found the patches easy or very easy to use&#59; 95&#46;4&#37; found the treatment schedule easy or very easy to follow&#46; In our case&#44; ease of use as perceived by caregivers was also consistent with ease of use reported by doctors&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Most of the caregivers expressed satisfaction with transdermal treatment&#44; as was the case in the randomised study mentioned above&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> In that study&#44; 90&#46;7&#37; of patients&#47;caregivers who switched from high-dose oral rivastigmine to a transdermal form were satisfied with the patches&#59; in contrast&#44; 79&#46;1&#37; of patients who continued with oral treatment were satisfied &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#46; In our study&#44; doctors expressed a higher degree of overall satisfaction than carers &#40;92&#46;9&#37; vs&#46; 76&#46;5&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#46; This discrepancy may be explained by a number of factors&#46; On the one hand&#44; the question used to evaluate overall satisfaction differed between these groups&#44; and each had different possible responses&#46; On the other hand&#44; the factors that determine satisfaction with treatment probably differ between caregivers and health professionals&#46; For caregivers&#44; satisfaction tends to depend on whether the treatment is user friendly and how it affects activities of daily life&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;11&#44;17</span></a> It is quite unlikely that a health professional would rate these considerations as more important than treatment efficacy or safety on a satisfaction questionnaire&#46; Caregivers were not optimistic that their patients would be able to self-administer their patches but we should point out that if AD patients were able to do so&#44; it would decrease the burden on their caregivers&#46; This could be a decisive factor for satisfaction in this group&#44; considering that a large percentage of the carers in this study were actively employed&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The study showed that CGI-C scores reported by both doctors and informal caregivers of AD patients are similar&#46; When these scores are compared to objective measuring instruments&#44; however&#44; we see that caregivers tend to overestimate neurological decline in their patients&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> In this study&#44; most caregivers reported improvement among patients after switching from oral to transdermal rivastigmine&#44; and they were significantly more likely to do so than doctors &#40;61&#46;4&#37; vs&#46; 53&#46;1&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&#46; Nevertheless&#44; no objective measurements of patient decline were performed that would enable us to assess these perceptions&#44; nor did we evaluate the correlation between their opinion and the doctors&#8217; opinion&#46; In contrast&#44; some of the caregivers did not perceive any differences in the status of the patient with respect to the previous treatment&#46; Caregivers are not always conscious of the fact that efficacy of an AD treatment often manifests as stabilisation of the patient&#39;s state&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> This lack of improvement perceived by some caregivers in our study may affect their level of satisfaction with the patch&#46; It suggests that clear communication between doctor and caregiver is needed in order to create realistic expectations for the treatment&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Patients treated with oral AChEI generally display low persistence&#46; A retrospective<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> study estimated that only 30&#46;8&#37; of patients remained in treatment with AChEI 6 months after having started&#59; use of low doses was cited as a risk factor for stopping treatment&#46; In our case&#44; persistence with transdermal rivastigmine reported at the 6-month mark was 87&#46;3&#37;&#46; This considerably higher figure may be partially due to the fact that all patients received high doses of rivastigmine&#46; Nevertheless&#44; the inherent advantages of the transdermal route are also likely to have had a strong impact&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The most frequent reason for stopping treatment was local skin reaction&#46; Although these are the most frequent reactions caused by treatment with transdermal drugs&#44; they tend to be mild to moderate in the case of rivastigmine patches&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> Cutaneous reactions can be lessened by changing patches daily&#44; and almost all caregivers in the study complied with this guideline&#46; In addition&#44; simple patient care routines&#44; such as removing the patch carefully and using emollients and topical corticosteroids&#44; decrease the impact of skin reactions&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> In addition&#44; there were few cases of stopping transdermal treatment due to gastrointestinal disorders or other adverse effects&#44; which confirms the good tolerability of this route&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Despite the high percentage of treatment permanence&#44; we observed only moderate treatment compliance &#40;57&#37;&#41;&#46; We did not record compliance for the patients&#8217; previous period of oral treatment&#46; Based on published evidence&#44; however&#44; it would be reasonable to think that compliance with transdermal treatment would be higher&#44; or at least that causes of poor compliance would be more easily avoidable than in oral treatment&#46; In an earlier prospective observational study in patients with poor adherence to oral treatment&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> researchers found that treatment compliance increased as patients switched from oral to transdermal treatment&#46; When the percentage of patch users was at 64&#46;8&#37;&#44; treatment compliance had reached 73&#46;6&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> This figure is higher than that obtained by our study&#46; In part&#44; the difference could be due to the way compliance was assessed&#46; In the prospective study&#44; patients were considered compliant if they forgot &#60;20&#37; of their doses and took their medication as prescribed &#62;80&#37; of the time&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Researchers have observed that patients taking tablets were more likely to forget their dose than patients using patches&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> This study shows a low rate of forgotten doses&#59; in fact&#44; most of the caregivers classified as non-compliant made a conscious decision not to adhere to treatment&#46; More than a third temporarily suspended the patches when patients experienced adverse events&#46; The same cause of treatment non-compliance has been reported among patients taking oral medications for chronic illnesses that resemble AD in that treatment benefits are not immediately apparent&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> This may indicate that caregivers for patients with AD will require additional training about the long-term benefits of treatment so that patients&#8217; experience with the transdermal route will yield optimal results&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In conclusion&#44; most informal caregivers preferred transdermal rivastigmine to oral rivastigmine&#46; Caregivers reported few incidents of forgetting doses and they indicated that the patch was easy to use and apply with little impact on the carer&#39;s daily routine&#46; Most caregivers expressed satisfaction with transdermal treatment&#44; and like the doctors&#44; they perceived overall improvement in patients who had switched from the previous treatment&#46; Studies report positive user experience results&#44; acceptance of the transdermal form&#44; and acceptable tolerability of the rivastigmine patch at high doses &#40;9&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41; in patients with AD who had previously been treated with high oral doses &#40;9&#8211;12<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#46; One implication of these data is that it may be beneficial to market rivastigmine patches with higher doses &#40;13&#46;3<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; as has been confirmed by more recent randomised trials&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Funding</span><p id="par0110" class="elsevierStylePara elsevierViewall">This study received financial support from <span class="elsevierStyleGrantSponsor" id="gs0005">Novartis Farmac&#233;utica&#44; S&#46;A</span>&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">Javier Ricart and Basilio Hern&#225;ndez are employed by Novartis Farmac&#233;utica&#44; SA&#46; Ram&#243;n Re&#241;&#233; has no conflicts of interest to declare with regard to this study&#46;</p></span></span>"
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            0 => "Alzheimer disease"
            1 => "Informal caregiver"
            2 => "Rivastigmine"
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            2 => "Rivastigmina"
            3 => "Satisfacci&#243;n"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Rivastigmine&#44; a treatment for mild to moderate Alzheimer disease &#40;AD&#41;&#44; is the first cholinesterase inhibitor to be available in the transdermal format&#46; We aim to describe user experience and satisfaction with the rivastigmine patch&#44; as well as any clinical changes perceived in patients&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Observational&#44; cross-sectional&#44; multicentre study with 239 investigators and 1851 informal caregivers of patients with mild to moderate AD&#46; Patients were treated with transdermal rivastigmine patches for &#8805;6 months and had previously received high doses of oral rivastigmine&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Mean caregiver age was 59&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;4<span class="elsevierStyleHsp" style=""></span>years and 70&#46;9&#37; were women&#46; They spent 10&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;1<span class="elsevierStyleHsp" style=""></span>hours per day providing care and 79&#46;8&#37; lived with the patient&#46; Patch instructions were described as easy to follow by 97&#46;1&#37; of the caregivers and 92&#46;1&#37; of them rated patch application as easy or very easy&#46; The most commonly cited disadvantage was adhesion problems &#40;26&#46;8&#37;&#41;&#46; Discontinuation of treatment was due to cutaneous reactions in most cases&#46; Overall&#44; 76&#46;5&#37; of the caregivers were satisfied or very satisfied with transdermal treatment and 77&#46;4&#37; considered that its interference with daily activities was minimal or null&#46; The patch was preferred to oral treatment by 94&#46;3&#37; of caregivers&#46; Clinical Global Impression of Change ratings improved according to 61&#46;3&#37; of the caregivers and 53&#37; of the investigators&#46; Few caregivers reported medication forgetfulness&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Most caregivers of patients with mild to moderate AD preferred the transdermal format of rivastigmine to the oral format&#46; Caregivers also reported overall satisfaction&#44; ease of use&#44; and reduced impact on daily activities for transdermal rivastigmine format&#44; in addition to patient improvement compared to their condition under the previous treatment&#46;</p>"
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      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Rivastigmina&#44; tratamiento para la enfermedad de Alzheimer &#40;EA&#41; leve-moderada&#44; es el primer inhibidor de la colinesterasa administrable por v&#237;a transd&#233;rmica&#46; Se describen la experiencia de uso y la satisfacci&#243;n de los cuidadores informales con los parches de rivastigmina&#44; as&#237; como el cambio cl&#237;nico percibido en los pacientes con su empleo&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; transversal y multic&#233;ntrico&#44; con 239 investigadores y 1851 cuidadores informales de pacientes con EA leve-moderada&#44; tratados con rivastigmina transd&#233;rmica durante &#8805;6 meses&#44; y que previamente recib&#237;an dosis altas de rivastigmina por v&#237;a oral&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La edad media de los cuidadores fue 59&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;4 a&#241;os &#40;70&#44;9&#37; mujeres&#41;&#46; El 79&#44;8&#37; compart&#237;a domicilio con el paciente&#44; dedicando 10&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;1<span class="elsevierStyleHsp" style=""></span>h&#47;d&#237;a a su cuidado&#46; Para la mayor&#237;a de los cuidadores las instrucciones del parche fueron comprensibles &#40;97&#44;1&#37;&#41; y la aplicaci&#243;n f&#225;cil o muy f&#225;cil &#40;92&#44;1&#37;&#41;&#46; La principal dificultad mencionada fueron problemas de adhesi&#243;n &#40;26&#44;8&#37;&#41;&#46; En general&#44; los abandonos del tratamiento se produjeron por reacciones cut&#225;neas&#46; El 76&#44;5&#37; de los cuidadores estuvieron satisfechos o muy satisfechos con el parche y el 77&#44;4&#37; consider&#243; que interfer&#237;a poco o nada en las actividades diarias propias&#46; El 94&#44;3&#37; prefiri&#243; la v&#237;a transd&#233;rmica respecto a la v&#237;a oral&#46; La Impresi&#243;n Cl&#237;nica Global de Cambio fue mejor en alg&#250;n grado para el 61&#44;3&#37; de los cuidadores y para el 53&#37; de los investigadores&#46; Se notificaron pocos olvidos de la medicaci&#243;n&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La mayor&#237;a de los cuidadores de pacientes con EA leve-moderada prefirieron la v&#237;a transd&#233;rmica de rivastigmina a la v&#237;a oral&#44; notificando satisfacci&#243;n global&#44; facilidad de uso e impacto reducido en sus actividades diarias propias con la ruta transd&#233;rmica&#44; as&#237; como mejora de los pacientes respecto al tratamiento anterior&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as&#58; Re&#241;&#233; R&#44; Ricart J&#44; Hern&#225;ndez B&#44; en representaci&#243;n de los investigadores del Estudio Experience&#46; Experiencia de uso y satisfacci&#243;n con rivastigmina transd&#233;rmica en cuidadores de pacientes con enfermedad de Alzheimer de leve a moderada previamente tratados con rivastigmina oral a dosis altas&#46; Neurolog&#237;a&#46; 2014&#59;29&#58;86&#8211;93&#46;</p>"
      ]
    ]
    "multimedia" => array:7 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2279
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Detailed reasons most frequently cited by caregivers of AD patients for not starting transdermal rivastigmine treatment &#40;A&#41; and for suspending transdermal rivastigmine treatment &#40;B&#41;&#46; Items 10 and 11 on the doctors&#8217; ad hoc questionnaire reporting on user experience&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1340
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            "Tamanyo" => 264981
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Caregivers&#8217; and researchers&#8217; overall satisfaction with the current treatment &#40;rivastigmine patch&#41; for patients with AD&#46; Items 7 and 5 from the respective ad hoc questionnaires&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1014
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Clinical Global Impressions-Change &#40;CGI-C&#41; rating for patient status&#44; provided by caregivers and doctors to compare patient health under current and previous treatments&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Caregiver compliance with transdermal rivastigmine treatment&#46; Adapted Morisky adherence scale&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">SD&#58; standard deviation&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Total carers <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1851&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Carer characteristics</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Age &#40;years&#41;&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sex &#40;female&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1313 &#40;70&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Educational level&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Primary education&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">807 &#40;43&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Secondary education&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">508 &#40;27&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Higher education&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">263 &#40;14&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>No studies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">252 &#40;13&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Employment status&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Retired&#47;Ineligible&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1173 &#40;63&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Employed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">628 &#40;33&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Unemployed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;2&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sharing household with patient &#40;yes&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1478 &#40;79&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Care description</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Time spent as patient&#39;s carer &#40;years&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Time spent performing care tasks per day &#40;hours&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Number of medications administered daily</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Time spent daily preparing and administering all of the patient&#39;s medications &#40;hours&#44; mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;59&nbsp;\t\t\t\t\t\t\n
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                0 => "xTab465340.png"
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          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Includes all daily doses of the patient&#39;s medications &#40;tablets&#44; inhalers&#44; patches&#44; etc&#46;&#41;&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Sociodemographic data from informal caregivers in the study&#59; description of the care they provide to their patients&#46;</p>"
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      ]
      5 => array:7 [
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Carers&#8217; experience&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Total carers<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1851&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Responsible for applying the patch &#40;carer&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1697 &#40;91&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Clarity of the instructions for patch use&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#8216;</span>Quite clear&#8217; or &#8216;clear&#8217;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1797 &#40;97&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#8216;</span>Somewhat unclear&#8217; or &#8216;completely unclear&#8217;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;4 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ease in applying the patch&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8216;Very easy&#8217; or &#8216;easy&#8217;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1705 &#40;92&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8216;Intermediate&#8217;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">137 &#40;7&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8216;Difficult&#8217; or &#8216;very difficult&#8217;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Main reasons for difficulty&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>The patch comes loose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;26&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Difficulty rotating patches to different locations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;15&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Difficulty opening the envelope&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;14&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Difficulties specific to individual carers<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;8&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Poor patient cooperation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;8&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Presence of hair in the application area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;3&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Whether the patch met initial expectations</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8216;Much better&#8217; or &#8216;somewhat better&#8217;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1173 &#40;63&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8216;Neither better nor worse&#8217;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">598 &#40;32&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8216;Significantly worse&#8217; or &#8216;much worse&#8217;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80 &#40;4&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">All items show the mean percentage &#40;standard deviation&#41; except where otherwise stated&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">AD&#58; Alzheimer disease&#59; AChEI&#58; acetylcholinesterase inhibitors&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Doctors&#8217; experience&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Total doctors<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>278&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Patients diagnosed with AD divided by total patients seen in the clinic</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;9 &#40;20&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Treated with AChEI<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;1 &#40;16&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Treated with rivastigmine<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;5 &#40;19&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Treated transdermally<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46;7 &#40;22&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Previously treated with oral rivastigmine<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#46;2 &#40;21&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Prior treatment with high-dose oral rivastigmine &#40;9&#8211;12<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#46;2 &#40;27&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Percentage of the total patients treated with transdermal rivastigmine who remain on that treatment after 3 months</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#46;5 &#40;10&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Percentage of the total patients treated with transdermal rivastigmine who remain on that treatment after 6 months</span>&nbsp;\t\t\t\t\t\t\n
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

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Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos