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New Publication on Alzheimer’s Disease Shows Patients with Behavioral Disturbances Benefit from Axura® (Memantine)
Frankfurt am Main, 13.05.2005
Alzheimer's disease is mostly associated with cognitive impairments, in particular the loss of short-term memory. In the initial stage of the disease this is in fact the most prominent symptom. But starting in the moderate stage of the disease, non-cognitive symptoms like functional adverse events and behavioral symptoms are dominant. These distinct behavioral symptoms can appear in the form of mood swings, anxiety, psychotic episodes, strong agitation, and aggression and are far more challenging for both patients as well as families and caregivers. They often lead to placement in a nursing home because the demands of the patient's difficult behavior are more than the family and caregivers can manage1.
According to a recent study conducted by S. Gauthier and associates that was just published in the International Journal of Geriatric Psychiatry, challenging behavioral symptoms like these - in particular agitation and aggression - can be positively influenced by therapy with Axura® (active ingredient: Memantine).² The basis for these findings was a clinical study conducted by Reisberg et al. in which 252 patients with moderate to severe Alzheimer's were treated with Memantine at a dose of 20 mg/day for 28 weeks.³ This was supported by additional data from a combination study by Tariot et al. where 404 patients with moderate to severe Alzheimer's disease who had been treated with an acetylcholinesterase inhibitor for at least 6 months (5 or 10 mg/day) received Memantine for 24 weeks (20 mg/day). 4 Both studies were randomized, double-blind, and placebo-controlled.
The changes in the behavioral disturbances were recorded in interviews with the caregivers on the basis of a Neuropsychiatric Inventory (NPI), a questionnaire that is used to assess behavioral disturbances in dementia patients.
Memantine Especially Effective for Agitation and Aggression
An analysis of the changes in comparison to baseline showed the advantages of the Memantine group in almost all behavioral symptoms assessed by the NPI scale. Above all aggression and agitation consistently and significantly improved in both studies in comparison to the placebo group. Moreover, Memantine exhibited positive effects on other behavioral disturbances such as delusions, irritability/lability, and depression/dysphoria. With its antagonistic activity at the NMDA-receptor, memantine modulates the glutamatergic neurotransmitter system. By supporting neurotransmission via the glutamatergic system, clinically relevant parameters like cognitive and functional capabilities as well as the global clinical outcome are improved or stabilized in comparison to no pharmacological treatment.
"The effects of memantine on the behavioral symptoms of Alzheimer's disease, particularly on symptoms of aggression and agitation are impressive," said Professor Serge Gauthier of McGill Research Centre for Studies in Aging in Quebec, Canada, who headed the analysis. "These results are of great relevance given there is a paucity of safe and effective treatments available for treating the particularly distressing and troublesome behavioral symptoms of Alzheimer's".
In patients who did not yet exhibit symptoms at the beginning of the study, the administration of Memantine significantly reduced the emergence of agitation and aggression from 58% to 27%. The same applies to the findings regarding the degree of severity of the agitation and aggression. Among the patients already affected by this pathology, 55% exhibited a noticeable improvement under the Memantine therapy as compared to 36% with the placebo. The researchers concluded that in daily treatment, the drug offers considerable relief for families and other caregivers.
Conclusion:
The occurrence of distinct behavioral symptoms in patients with Alzheimer's is increasingly viewed as one of the primary problems associated with the disease. This applies in particular to the often pronounced symptoms of agitation and aggression that frequently stand in the way of home treatment and tend to make nursing home placement unavoidable.
The recent results of an analysis by S. Gauthier demonstrate that the treatment of Alzheimer's disease with the NMDA antagonist Memantine is also capable of reducing especially challenging symptoms such as these. This is not only expected to relieve the burden on patients and all caregivers, but potentially also delays the need to place patients in nursing homes.
In addition to these data, economic healthcare advantages and cost savings of Memantine therapy have been shown in earlier publications.5
References:
1 Ferris S.H. et al. (1987): Institutionalization of Alzheimer`s disease patients:reducing precipitating factors through family counselling. Home Health Care Serv Q 8: 23 - 51
2 Gauthier S., Wirth Y. Möbius H.J. (2005): Effects of memantine in behavioural symptoms in Alzheimer`s disease patients: an analysis of the Neuropsychiatric Inventory (NPI) data of two randomized, controlled studies
3 Reisberg B. et al.(2003): Memantine in moderate-to-severe Alzheimer`s disease. N Engl J Med 348: 1333-1341
4 Tariot P.N. et al. (2004): Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial. JAMA 291: 317-324
5 Wimo A. et al. (2003): Resource utilization and cost analysis of memantine in patients with moderate to severe Alzheimer`s disease. Pharmacoeconomics 21: 327-340
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