Memantine Eases Daily Life for Patients and Caregivers

Introduction

Memantine is one of the essential drugs used in the treatment of Alzheimer's dementia. In the Czech Republic, it is covered by public health insurance for patients with an MMSE (Mini-Mental State Examination) score of 6-19 points. However, at MMSE values of 18-19 points, memantine is covered only for patients who cannot tolerate drugs from the group of acetylcholinesterase inhibitors.

Methodology and Study Progress

A 6-month open-label study of memantine treatment was conducted between 2007 and 2009, enrolling 1001 patients with moderate to severe Alzheimer's disease (MMSE score of 6-19 points) treated at neurology and psychiatry clinics in the Czech Republic, with an average age of 78.4 years. Nearly 70% of the patients had an initial MMSE score between 12 and 17 points. Memantine was titrated weekly by 5 mg up to a dose of 20 mg per day from the fourth week of the study. Evaluations were conducted at the start of the study and at follow-ups at 2, 4, and 6 months.

The overall clinical impression was assessed by physicians using the CGI-S (Clinical Global Impression – Severity) and CGI-C (Clinical Global Impression – Change) scales. Cognition was assessed using the MMSE test, and the ability to perform basic daily activities was assessed using the ADL (Activities of Daily Living) test by Barthel. The frequency and severity of neuropsychiatric symptoms in dementia were measured using a simplified NPI (Neuropsychiatric Inventory) questionnaire. The burden on caregivers was assessed using a shortened modified ZBI (Zarit Burden Interview) scale. Another parameter was the frequency of adverse effects.

Results

Significant statistical improvement (p < 0.001) was noted in the health status of all major scales during the treatment. Only in the ADL scale was there no statistically significant improvement between the third and fourth follow-ups. Significant improvement was also observed in all subscales of the NPI (p < 0.001).

When evaluating the dependence of treatment success on the initial MMSE scale value, it was found that there was no statistically significant difference in treatment success between patients with an initial MMSE of 18-19 points and those with an initial MMSE of 6-17 points, as confirmed by the MMSE (p = 0.434), NPI (p = 0.196), and CGI (p = 0.118) scales.

The occurrence of adverse effects of memantine was rare. At the first follow-up, they appeared in 9 patients (0.9%), and their occurrence decreased with each subsequent follow-up. During the fourth follow-up, only 1 patient had adverse effects. The most common adverse effects were increased agitation, headache, increased restlessness, and nausea. No serious adverse effects were recorded.

Discussion and Conclusion

This open-label study confirmed, similar to previous studies, the efficacy and safety of memantine in the treatment of moderate to severe dementia in Alzheimer's disease in routine clinical practice in the Czech Republic. Besides improving cognitive performance and daily activity performance, there was also a significant reduction in the occurrence of neuropsychiatric symptoms. This therapeutic effect is practically significant for delaying the institutionalization of patients and, last but not least, for reducing the burden on caregivers.

The study also demonstrated the efficacy of memantine in patients with an initial MMSE score of 18 and 19, comparable to its efficacy in patients with more severe cognitive impairment. This confirms the appropriateness of prescribing memantine to a wide range of patients and underscores the importance of early diagnosis and therapy.

(dos)

Source: Konrád J., Hanyš R., Dvořák A., Rozehnalová E. Memantine in the treatment of moderate to severe dementia in Alzheimer's disease. A six-month open-label study of 1001 patients. Assessment of caregiver burden and treatment efficacy in a group of patients with an MMSE of 18 and 19 points. Czech and Slovak Psychiatry 2011; 107 (5): 257–262.