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Memantine benefits functional abilities in moderate to severe Alzheimer's disease.

Abstract

OBJECTIVE

Functional abilities are severely impacted in Alzheimer's disease (AD). Loss of the ability to perform complex (instrumental) and basic activities of daily living (ADL), leads to decreased independence and increased caregiver burden. This post-hoc analysis investigated the effect of memantine (20 mg/day) on ADLs, as measured by Alzheimer's Disease Cooperative Study-Activities of Daily Living 19-item (ADCS-ADL19) and 23-item (ADCS-ADL23) scales, in patients with moderate-to-severe AD.

DESIGN

Data were pooled from six multicenter, randomized, placebo-controlled, double-blind, 6-month studies of memantine 20 mg/day.

PARTICIPANTS

Male and female patients aged ≥ 50 years at baseline with a Mini Mental State Examination (MMSE) score < 20.

MEASUREMENTS

ADCS-ADL19 and ADCS-ADL23 scales were pooled, and 14 shared items, with a score range of 0-45, were identified and included in the analysis (ADL14). Basic ADLs (BADLs) were defined as: eating, walking, toileting, bathing, and grooming. Instrumental ADLs (IADLs) were defined as: using a telephone, watching television, conversing, clearing a table, finding belongings, obtaining a beverage, disposing of household rubbish, travelling outside the house, and being left alone. Changes from baseline on single-item, BADL (range: 0-15), IADL (range: 0-30), and total ADL14 scores were analysed for observed cases using ANCOVA, with study, center and treatment as categorical explanatory variables and score at baseline as a covariate.

RESULTS

959 patients were treated with memantine and 867 patients received placebo. Memantine-treated patients had less decline from baseline on the ADL14 total score, compared with placebo (p < 0.001) at study end. Memantine also showed lower reductions in BADLs (p < 0.05) and IADLs (p < 0.001), for observed cases, compared with placebo. Memantine-treated patients showed less worsening than placebo recipients for the ADL items: toileting (p < 0.01), grooming (p < 0.01), finding belongings (p < 0.01), and travelling outside the house (p < 0.05).

CONCLUSION

Compared with placebo, memantine shows benefits for both basic and instrumental ADLs in patients with moderate-to-severe AD, suggesting that memantine treatment may lead to a more interactive and dignified life for patients with moderate-to-severe AD.

Links

Authors+Show Affiliations

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Karolinska Institutet, Alzheimer Disease Research Center (KI-ADRC) NOVUM, Huddinge, Sweden. bengt.winblad@ki.se

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Source

MeSH

Activities of Daily Living
Aged
Aged, 80 and over
Alzheimer Disease
Analysis of Variance
Double-Blind Method
Excitatory Amino Acid Antagonists
Female
Humans
Male
Memantine
Middle Aged
Randomized Controlled Trials as Topic

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21085908

Citation

Winblad, B, et al. "Memantine Benefits Functional Abilities in Moderate to Severe Alzheimer's Disease." The Journal of Nutrition, Health & Aging, vol. 14, no. 9, 2010, pp. 770-4.
Winblad B, Gauthier S, Aström D, et al. Memantine benefits functional abilities in moderate to severe Alzheimer's disease. J Nutr Health Aging. 2010;14(9):770-4.
Winblad, B., Gauthier, S., Aström, D., & Stender, K. (2010). Memantine benefits functional abilities in moderate to severe Alzheimer's disease. The Journal of Nutrition, Health & Aging, 14(9), pp. 770-4.
Winblad B, et al. Memantine Benefits Functional Abilities in Moderate to Severe Alzheimer's Disease. J Nutr Health Aging. 2010;14(9):770-4. PubMed PMID: 21085908.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Memantine benefits functional abilities in moderate to severe Alzheimer's disease. AU - Winblad,B, AU - Gauthier,S, AU - Aström,D, AU - Stender,K, PY - 2010/11/19/entrez PY - 2010/11/19/pubmed PY - 2011/5/5/medline SP - 770 EP - 4 JF - The journal of nutrition, health & aging JO - J Nutr Health Aging VL - 14 IS - 9 N2 - OBJECTIVE: Functional abilities are severely impacted in Alzheimer's disease (AD). Loss of the ability to perform complex (instrumental) and basic activities of daily living (ADL), leads to decreased independence and increased caregiver burden. This post-hoc analysis investigated the effect of memantine (20 mg/day) on ADLs, as measured by Alzheimer's Disease Cooperative Study-Activities of Daily Living 19-item (ADCS-ADL19) and 23-item (ADCS-ADL23) scales, in patients with moderate-to-severe AD. DESIGN: Data were pooled from six multicenter, randomized, placebo-controlled, double-blind, 6-month studies of memantine 20 mg/day. PARTICIPANTS: Male and female patients aged ≥ 50 years at baseline with a Mini Mental State Examination (MMSE) score < 20. MEASUREMENTS: ADCS-ADL19 and ADCS-ADL23 scales were pooled, and 14 shared items, with a score range of 0-45, were identified and included in the analysis (ADL14). Basic ADLs (BADLs) were defined as: eating, walking, toileting, bathing, and grooming. Instrumental ADLs (IADLs) were defined as: using a telephone, watching television, conversing, clearing a table, finding belongings, obtaining a beverage, disposing of household rubbish, travelling outside the house, and being left alone. Changes from baseline on single-item, BADL (range: 0-15), IADL (range: 0-30), and total ADL14 scores were analysed for observed cases using ANCOVA, with study, center and treatment as categorical explanatory variables and score at baseline as a covariate. RESULTS: 959 patients were treated with memantine and 867 patients received placebo. Memantine-treated patients had less decline from baseline on the ADL14 total score, compared with placebo (p < 0.001) at study end. Memantine also showed lower reductions in BADLs (p < 0.05) and IADLs (p < 0.001), for observed cases, compared with placebo. Memantine-treated patients showed less worsening than placebo recipients for the ADL items: toileting (p < 0.01), grooming (p < 0.01), finding belongings (p < 0.01), and travelling outside the house (p < 0.05). CONCLUSION: Compared with placebo, memantine shows benefits for both basic and instrumental ADLs in patients with moderate-to-severe AD, suggesting that memantine treatment may lead to a more interactive and dignified life for patients with moderate-to-severe AD. SN - 1760-4788 UR - https://www.unboundmedicine.com/medline/citation/21085908/Memantine_benefits_functional_abilities_in_moderate_to_severe_Alzheimer's_disease_ L2 - https://medlineplus.gov/alzheimersdisease.html DB - PRIME DP - Unbound Medicine ER -