Memantine was lately approved by th...

Memantine was lately approved by the U.S. pabulum and Drug Administration for the treatment of moderate to hard Alzheimer's disease. It is the first remedy in a new class called N-methyl-aspartate (NMDA) receptor antagonist. Tariot and colleagues assessed the clinical efficacy, safety, and tolerability of memantine in patients onward a stable regimen of donepezil therapy.

In this double-blinded, multicenter trial, 203 participants with moderate to chaste Alzheimer's disease were randomized to receive treatment with memantine for 24 weeks, following a one- or two-week single-blinded lead-in period, and 201 received placebo. All patients had been taking a stable dosage of donepezil for at least six month at avenue and were required to continue this baseline remedy for the duration of the trial.

issue measures included cognition, function, and global performance, as measured by way of the Severe Impairment Battery (SIB) and a modified AD Cooperative Study--Activities of Daily Living Inventory (ADCS--ADL). Secondary issue measures included performance on additional rating scales: the Clinician's Interview-Based Impression of Change Plus Caregiver Input (CIBIC-Plus), the Neuropsychiatric Inventory (NPI), and the Behavioral Rating Scale for Geriatric Patients (BGP)

Significantly more patients complet the memantine arm of the studious mood than the placebo arm. There was a statistically significant improvement in patients taking memantine in the one and the other primary outcomes. The mean CIBIC-Plus score was significantly better in the memantine cluster and 55 per-cent of the patients taking memantine were rated as improved or unchanged compared with 45 percent of the placebo collection There were fewer behavioral disturbances and psychiatric symptoms, as measured by the agency of the NPI score, in the patients taking memantine. In addition, the BGP colony subscale was significantly improved with memantine use. More participants in the placebo dispose discontinued therapy because of adverse imports The adverse effect most many times associated with discontinuation was confusion.

The authors judge that the efficacy of memantine is significantly better than that of placebo in the treatment of moderate to relentless Alzheimer's disease in patients taking stable dosages of donepezil, as measured on cognitive function, activities of daily living, behavior, and clinical global status.

Tariot PN et al. Memantine treatment in patients with moderate to chaste Alzheimer disease already receiving donepezil. A randomized controll trial. JAMA January 21 2004;291:317-24

EDITOR'S NOTE: Memantine can be an expensive option. A modern review found that memantine, in dosages of 20 mg by day, had beneficial effects forward cognition and function but not forward clinical impression of change when compared with placebo. (1) The clinical impression of change is considered an essential adjunct to basic cognitive and functional scales. However, because greatest in quantity of the health care require to be paid [i]or[/i] undergones of Alzheimer's disease relate to advanced disease, memantine may be cost-effective calm if the absolute clinical benefits are small. (2)--CW

REFERENCES

(1) Areosa Sastre A, Sherriff F Memantine for dementia. Cochrane Database Syst Rev 2004;3:CD003154

(2) Wilcock GK Memantine for the treatment of dementia. Lancet Neurol 2003;2:503-5

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