Citicoline Plus Memantine Superior to Memantine Alone for Improving Cognition in Alzheimer's Dementia
Patients in the combination treatment arm experienced a greater increase in MMSE scores between baseline and at 6 months compared with those receiving memantine monotherapy.
|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 – Preliminary data presented at the 2018 Alzheimer's Association International Conference, held July 22-26, 2018 in Chicago, Illinois, demonstrated that a combination of citicoline plus memantine may improve cognition in patients with Alzheimer disease (AD) and mixed dementia. The findings were presented by lead study author and researcher Pietro Gareri, MD, PhD.
Citicoline, which is predominantly used to treat degenerative and vascular cognitive impairment, increases acetylcholine intrasynaptic levels and facilitates phospholipid synthesis, neuronal repair, and cellular function. Memantine, an N-methyl-D-aspartate receptor antagonist, is commonly used for treating patients with mild to moderate AD. “When co-administered they could have a synergistic action in patients affected with AD and mixed dementia,” the researchers wrote. “The aim of the present study was to show the effectiveness of oral citicoline plus memantine in patients affected with AD and mixed dementia.”
In their retrospective study, the researchers reviewed outcomes of a combination therapy comprised of citicoline plus memantine in consecutive patients with AD and mixed dementia (N=120; mean age 81.04 ± 5.1 years old). Patients were treated with either memantine monotherapy (n=58) or an orally administered 1 g/day citicoline plus memantine combination treatment (n=62). Memantine doses varied between 10 mg-20 mg/day in both arms, with exact dosage depending on patient tolerability.
In the memantine monotherapy group, a total of 22 patients had mixed dementia vs 27 patients treated with combination therapy. The investigators assessed cognitive function using the Mini-Mental State Examination (MMSE), behavioral symptoms (Neuropsychiatric Inventory Questionnaire), mood (Geriatric Depression Scale-short form), comorbidities (Cumulative Illness Rating Scale), and daily life functions (Activities of Daily Living [ADL] and instrumental ADL).
Change in cognitive function from baseline to 6 months and 12 months comprised the primary outcome. Additionally, side effects or adverse events as well as the impact of each treatment on daily life functions and behavioral symptoms were included as secondary outcome measures.
Patients in the combination treatment arm experienced a greater increase in MMSE scores between baseline and at 6 months compared with those receiving memantine monotherapy (16.6 ± 2.69 vs 17.4 ± 2.71, respectively; P =.000). In addition, treatment with citicoline plus memantine vs memantine monotherapy resulted in a significantly greater improvement in cognitive scores between 6 months and 12 months (17.4 ± 2.71 vs 17.7 ± 2.8, respectively; P =.000).
“Since it is important to maximize the present pharmacological means in AD and mixed dementia,” the investigators added, “this study encourages the role of combined administration of memantine plus citicoline in disease management by slowing disease progression.”
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Gareri P, Cotroneo AM, Putignano S. The Citimem study: citicoline plus memantine in aged patients affected with Alzheimer's disease and mixed dementia study. preliminary data. Presented at: 2018 Alzheimer's Association International Conference. July 22-26, 2018; Chicago, IL. Abstract 24105.