Skinfold thickness for rivastigmine patch application in Alzheimer’s disease

  • Ping-Song Chou
  • Kai-Ming Jhang
  • Ling-Chun Huang
  • Wen-Fu WangEmail author
  • Yuan-Han YangEmail author
Original Investigation



Rivastigmine patches are used for patients with Alzheimer’s disease (AD), but little is known about the serum concentration of rivastigmine and its metabolite or clinical adherence in relation to skinfold thickness after rivastigmine patch application.


The aim of this study was to examine the association between rivastigmine and NAP 226-90 serum concentration and skinfold thickness and to determine the appropriate skinfold thickness for the use of rivastigmine patch in patients with AD.


Patients with AD who continuously used rivastigmine patches (4.6 mg/24 h, 5 cm2) for more than 6 months were recruited. The serum concentrations of rivastigmine and NAP 226-90 were measured. Skinfold thickness was measured using a Lange Skinfold Caliper.


In total, 91 patients with AD (40 men and 51 women) participated in this study on skinfold thickness measurement. Among them, 27 patients were examined for rivastigmine and NAP 226-90 serum concentrations, with mean concentrations of 1.0 ± 0.6 ng/mL and 3.6 ± 3.6 ng/mL, respectively. The skinfold thickness in the subscapular area was significantly negatively correlated with the NAP 226-90 serum concentration (Spearman’s rank correlation coefficient = − 0.47, P = .01). In addition, patients with AD and a subscapular skinfold thickness of ≥25 mm exhibited a significantly high risk of decreased Mini-Mental Status Examination score and nonadherence to a rivastigmine patch (odds ratio 3.00; 95% confidence interval = 1.076–8.366, P = .03).


Subscapular skinfold thickness was significantly negatively correlated with the NAP 226-90 serum concentration and may be considered an appropriate predictor of response and adherence to clinical application of a rivastigmine patch.


Alzheimer’s disease NAP 226-90 Rivastigmine patch Skinfold thickness 



This manuscript was edited by Wallace Academic Editing.


This study was supported by grants from Kaohsiung Medical University Hospital (KMUH-9M40) and Kaohsiung Medical University and Changhua Christian Hospital (105-CCH-KMU-011).

Compliance with ethical standards

All procedures were approved by the Institutional Review Boards of Changhua Christian Hospital and Kaohsiung Medical University Hospital. All of the participants or their legal representatives provided written informed consent.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of and Master’s Program in Neurology, Faculty of Medicine, College of Medicine, and Neuroscience Research CenterKaohsiung Medical UniversityKaohsiungTaiwan
  2. 2.Department of NeurologyKaohsiung Medical University HospitalKaohsiungTaiwan
  3. 3.Department of NeurologyChanghua Christian HospitalChanghuaTaiwan
  4. 4.Department of Neurology, Kaohsiung Municipal Ta-Tung HospitalKaohsiung Medical UniversityKaohsiungTaiwan
  5. 5.Department of Holistic WellnessMing Dao UniversityChanghuaTaiwan

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