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 J. Caselli, Dean M. Wingerchuk, Bart M. Demaerschalk

Research output: Contribution to journalArticle

17 Scopus citations

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 1 2011

Keywords

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

ASJC Scopus subject areas

  • Clinical Neurology

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