Memantine and Acetylcholinesterase Inhibitor Treatment in Cases of CDR 0.5 or Questionable Impairment

Article type: Research Article

Authors: McClendon, McKee J.^a | Hernandez, Santiago^b | Smyth, Kathleen A.^{a; c; d} | Lerner, Alan J.^{a; d; e; *}

Affiliations: [a] University Memory and Aging Center, Cleveland, OH, USA | [b] School of Medicine, Case Western Reserve University, Cleveland, OH, USA | [c] Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA | [d] Department of Neurology, Case Western Reserve University, Cleveland, OH, USA | [e] University Hospitals Case Medical Center, Cleveland, OH, USA

Correspondence: [*] Corresponding author: Alan J. Lerner, MD, Memory and Cognition Center, 12200 Fairhill Road, Cleveland, OH 44120, USA. Tel.: +1 216 844 6400; Fax: +1 216 844 6331; E-mail: alan.lerner@case.edu.

Note: [] Communicated by Marwan Sabbagh

Abstract: The biological meaning of uncertain dementia ratings (CDR 0.5) and its treatment implications are unclear. Our study examines the frequency of anti-dementia medication use in individuals with CDR 0.5 and the cognitive, behavioral, and demographic factors associated with memantine and acetylcholinesterase inhibitor (AChEI) use. Subjects were drawn from the National Alzheimer Coordinating Center database, which collects data from 30 Alzheimer Disease Centers. There were 2,512 subjects with the following diagnoses: Normal, 11.8%; Mild cognitive impairment, 44.6%; Alzheimer's disease, 34.9%; and other dementias, 8.7%. Overall, 35% used AChEIs and 13% used memantine. AChEI and memantine use was greater in subjects who were referred by clinics and diagnosed with Alzheimer's disease. AChEI use was associated with being married, younger, male, and more educated while memantine use was associated with less severe apathy and other dementia diagnosis. Non-Hispanic whites were more likely to use AChEI and memantine than non-Hispanic blacks (OR = 2.2, 2.5). Hispanics were more likely to use AChEI than non-Hispanic blacks. It appears anti-dementia medication use in CDR 0.5 is frequent and represents evidence for extensive off label usage. Diagnosis, severity of impairment, and race, among other variables, affect the likelihood of AChEI and memantine use in this population.

Keywords: Acetylcholinesterase inhibitors, Alzheimer's disease, CDR 0.5, disparity, ethnicity, memantine, mild cognitive impairment, off label, race

DOI: 10.3233/JAD-2009-0994

Journal: Journal of Alzheimer's Disease, vol. 16, no. 3, pp. 577-583, 2009