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Improvement in behavioural symptoms in patients with moderate to severe Alzheimer's disease by memantine: a pooled data analysis.
Int J Geriatr Psychiatry. 2008 May; 23(5):537-45.IJ

Abstract

INTRODUCTION

Behavioural disturbances are a common and distressing aspect of Alzheimer's disease (AD). This pooled analysis evaluated the specific benefits of memantine on behavioural disturbances in patients with moderate to severe AD.

METHODS

Data were pooled from six 24/28-week, randomised, placebo-controlled, double-blind studies. Of the 2,311 patients included in these studies, 1,826 patients with moderate to severe AD (MMSE <20) were included in this analysis, corresponding to the extended indication for memantine in Europe. In this subgroup, 959 patients received memantine 20 mg/day and 867 received placebo. Behavioural symptoms were rated using the Neuropsychiatric Inventory (NPI) total and single-item scores at weeks 12 and 24/28.

RESULTS

At weeks 12 and 24/28, ITT analysis demonstrated that memantine treatment produced statistically significant benefits over placebo treatment in NPI total score (p=0.001 and p=0.008), and in NPI single items: delusions (p=0.007 week 12, p=0.001 week 24/28), hallucinations (p=0.037 week 12), agitation/aggression (p=0.001 week 12, p=0.001 week 24/28), and irritability/lability (p=0.005 week 24/28), LOCF population. Analysis of the patients without symptoms at baseline indicated reduced emergence of agitation/aggression (p=0.002), delusions (p=0.047), and disinhibition (p=0.011), at week 12, and of agitation/aggression (p=0.002), irritability/lability (p=0.004), and night-time behaviour (p=0.050) at week 24/28 in those receiving memantine. OC analyses yielded similar results.

CONCLUSIONS

The data suggest that memantine is effective in treating and preventing the behavioural symptoms of moderate to severe AD. Specific persistent benefits were observed on the symptoms of delusions and agitation/aggression, which are known to be associated with rapid disease progression, increased caregiver burden, early institutionalisation, and increased costs of care.

Authors+Show Affiliations

Gauthier S
MCSA Alzheimer's Disease Research Unit, McGill Centre for Studies in Aging, Quebec, Canada. serge.gauthier@mcgill.ca
Loft H
No affiliation info available
Cummings J
No affiliation info available

MeSH

AgedAged, 80 and overAlzheimer DiseaseAntiparkinson AgentsBehavioral SymptomsExcitatory Amino Acid AntagonistsFemaleHumansMaleMemantineNeuropsychological TestsRandomized Controlled Trials as TopicTreatment Outcome

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18058838

Citation

Gauthier, S, et al. "Improvement in Behavioural Symptoms in Patients With Moderate to Severe Alzheimer's Disease By Memantine: a Pooled Data Analysis." International Journal of Geriatric Psychiatry, vol. 23, no. 5, 2008, pp. 537-45.
Gauthier S, Loft H, Cummings J. Improvement in behavioural symptoms in patients with moderate to severe Alzheimer's disease by memantine: a pooled data analysis. Int J Geriatr Psychiatry. 2008;23(5):537-45.
Gauthier, S., Loft, H., & Cummings, J. (2008). Improvement in behavioural symptoms in patients with moderate to severe Alzheimer's disease by memantine: a pooled data analysis. International Journal of Geriatric Psychiatry, 23(5), 537-45.
Gauthier S, Loft H, Cummings J. Improvement in Behavioural Symptoms in Patients With Moderate to Severe Alzheimer's Disease By Memantine: a Pooled Data Analysis. Int J Geriatr Psychiatry. 2008;23(5):537-45. PubMed PMID: 18058838.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improvement in behavioural symptoms in patients with moderate to severe Alzheimer's disease by memantine: a pooled data analysis. AU - Gauthier,S, AU - Loft,H, AU - Cummings,J, PY - 2007/12/7/pubmed PY - 2008/12/17/medline PY - 2007/12/7/entrez SP - 537 EP - 45 JF - International journal of geriatric psychiatry JO - Int J Geriatr Psychiatry VL - 23 IS - 5 N2 - INTRODUCTION: Behavioural disturbances are a common and distressing aspect of Alzheimer's disease (AD). This pooled analysis evaluated the specific benefits of memantine on behavioural disturbances in patients with moderate to severe AD. METHODS: Data were pooled from six 24/28-week, randomised, placebo-controlled, double-blind studies. Of the 2,311 patients included in these studies, 1,826 patients with moderate to severe AD (MMSE <20) were included in this analysis, corresponding to the extended indication for memantine in Europe. In this subgroup, 959 patients received memantine 20 mg/day and 867 received placebo. Behavioural symptoms were rated using the Neuropsychiatric Inventory (NPI) total and single-item scores at weeks 12 and 24/28. RESULTS: At weeks 12 and 24/28, ITT analysis demonstrated that memantine treatment produced statistically significant benefits over placebo treatment in NPI total score (p=0.001 and p=0.008), and in NPI single items: delusions (p=0.007 week 12, p=0.001 week 24/28), hallucinations (p=0.037 week 12), agitation/aggression (p=0.001 week 12, p=0.001 week 24/28), and irritability/lability (p=0.005 week 24/28), LOCF population. Analysis of the patients without symptoms at baseline indicated reduced emergence of agitation/aggression (p=0.002), delusions (p=0.047), and disinhibition (p=0.011), at week 12, and of agitation/aggression (p=0.002), irritability/lability (p=0.004), and night-time behaviour (p=0.050) at week 24/28 in those receiving memantine. OC analyses yielded similar results. CONCLUSIONS: The data suggest that memantine is effective in treating and preventing the behavioural symptoms of moderate to severe AD. Specific persistent benefits were observed on the symptoms of delusions and agitation/aggression, which are known to be associated with rapid disease progression, increased caregiver burden, early institutionalisation, and increased costs of care. SN - 0885-6230 UR - https://www.unboundmedicine.com/medline/citation/18058838/Improvement_in_behavioural_symptoms_in_patients_with_moderate_to_severe_Alzheimer's_disease_by_memantine:_a_pooled_data_analysis_ DB - PRIME DP - Unbound Medicine ER -