Memantine Plus Cholinesterase Inhibitors Improves Psychosis, Neurobehavioral Symptoms in Alzheimer Disease

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Investigators pooled data from patients from 3 phase 3, 24-week, randomized, placebo-controlled trials of MEM in patients with Alzheimer disease receiving concurrent ChEIs.
Investigators pooled data from patients from 3 phase 3, 24-week, randomized, placebo-controlled trials of MEM in patients with Alzheimer disease receiving concurrent ChEIs.

The following article is part of conference coverage from the 2018 Alzheimer's Association International Conference in Chicago, Illinois. Neurology Advisor's staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AAIC 2018.

CHICAGO – Cholinesterase inhibitors (ChEIs) plus memantine (MEM) may provide a significant benefit for psychosis and neurovegetative behavioral syndromes in patients with Alzheimer disease, according to results of a post-hoc analysis presented at the 2018 Alzheimer's Association International Conference, July 22-26, 2018, in Chicago, Illinois.

Investigators led by Jeffrey L. Cummings, MD, director of the Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas, California pooled data from patients from 3 phase 3, 24-week, randomized, placebo-controlled trials of MEM in patients with Alzheimer disease receiving concurrent ChEIs. They evaluated the effects of MEM treatment by measuring improvements in items on the Neuropsychiatric Inventory (NPI), which were grouped into 4 syndrome domains: psychosis (agitation/aggression, hallucinations, delusions, irritability/lability), neurovegetative (aberrant motor behavior, nighttime behavior, appetite/eating change), frontal (disinhibition, euphoria/elation), and mood (anxiety, depression/dysphoria, apathy).

The investigators evaluated data from 1262 patients, 637 of which received MEM and ChEIs and 625 received placebo and ChEIs (mean age, 75.7; baseline Mini Mental State Exam score, 11.5; baseline NPI, 14.9).

Overall, mean treatment differences favored combination treatment with MEM/ChEIs. Specifically, psychosis symptoms significantly improved in the group who received MEM/ChEIs compared with those who received placebo/ChEIs at 12 (least squares mean difference (LSMD) -1.167; P <.0001) and 24 weeks (LSMD -1.238; P <.0001). A similar effect was seen for neurovegetative symptom scores in patients who received MEM/ChEIs (LSMD -0.621; P =.0103) vs those who received placebo/ChEIs (LSMD -0.583; P =.0441). Notably, no significant differences were observed for frontal or mood symptoms in either treatment group.

Ultimately, treatment with MEM plus ChEIs resulted in significant improvements in psychosis and neurobehavioral syndromes compared to patients who received ChEIs alone.

Disclosures: This study was supported by Allergan plc.

For more coverage of AAIC 2018, click here.

Reference

Cummings JL, Grossberg GT, Porsteinsson AP, Hendrix S, Ellison N, Kerolous M. The effects of memantine added to cholinesterase inhibitors on NPI behavioral domains: pooled post hoc analysis of 3 randomized controlled trials in patients with moderate to severe AD. Presented at: 2018 Alzheimer's Association International Conference. July 22-26, 2018; Chicago, IL. Poster P1-069.

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