Effectiveness of adding memantine to an alzheimer dementia treatment regimen which already includes stable donepezil therapy: A critically appraised topic

Katherine C. Riordan, Charlene R. Hoffman Snyder, Kay E. Wellik, Richard John Caselli, Dean Marko Wingerchuk, Bart M Demaerschalk

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Alzheimer dementia (AD) is a major cause of debility and economic strain in aging societies around the world. The only 2 medication classes approved specifically for the treatment of AD are the cholinesterase inhibitors (donepezil, rivastigmine, and galantamine) and memantine. Evidence that the use of memantine in a patient already on cholinesterase inhibitor therapy can provide a clinically significant benefit is limited. Objective: To review the evidence supporting the addition of memantine therapy in patients with moderate-to-severe AD who are already receiving treatment with a cholinesterase inhibitor. Methods: The objective was addressed through the development of a critically appraised topic which included a clinical scenario, structured question, search strategy, critical appraisal, results, evidence summary, commentary, and bottom line Conclusions. Included were neurology consultants and residents, a medical librarian, clinical epidemiologists, and content experts in the field of behavioral neurology. Results: One article was selected for review. Patients receiving memantine for 24 weeks experienced a statistically significant change from baseline on a modified 19-item AD Cooperative Study-Activities of Daily Living Inventory (P=0.03) and on the Severe Impairment Battery (P=0.001) when compared with placebo. The change in mean scores in the memantine group versus placebo on the 19-item AD Cooperative Study-Activities of Daily Living Inventory were-2.0 versus-3.4 and on the Severe Impairment Battery 0.9 versus-2.5 which indicate improved performance or reduced deterioration in the memantine group. The number needed to treat and the effect size could not be calculated from the data provided. Conclusions: The addition of memantine to donepezil in patients with moderate-to-severe AD provides a statistically significant improvement in several AD-oriented outcome measures, however, the clinical relevance of this benefit remains unclear.

Original languageEnglish (US)
Pages (from-to)121-123
Number of pages3
JournalNeurologist
Volume17
Issue number2
DOIs
StatePublished - Mar 2011

Fingerprint

Memantine
Alzheimer Disease
Cholinesterase Inhibitors
Rivastigmine
Neurology
Activities of Daily Living
Therapeutics
Placebos
Galantamine
Librarians
Numbers Needed To Treat
Equipment and Supplies
Consultants
donepezil
Economics
Outcome Assessment (Health Care)

Keywords

  • Alzheimer disease
  • cholinesterase inhibitors
  • critically appraised topic
  • donepezil
  • evidence-based medicine
  • memantine

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Effectiveness of adding memantine to an alzheimer dementia treatment regimen which already includes stable donepezil therapy : A critically appraised topic. / Riordan, Katherine C.; Hoffman Snyder, Charlene R.; Wellik, Kay E.; Caselli, Richard John; Wingerchuk, Dean Marko; Demaerschalk, Bart M.

In: Neurologist, Vol. 17, No. 2, 03.2011, p. 121-123.

Research output: Contribution to journalArticle

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