Retrospective Study on the Benefits of Combined Memantine and cholinEsterase inhibitor treatMent in AGEd Patients affected with Alzheimer's Disease: The MEMAGE Study

Article type: Research Article

Authors: Gareri, Pietro^{a; *} | Putignano, Daria^b | Castagna, Alberto^c | Cotroneo, Antonino Maria^d | De Palo, Grazia^e | Fabbo, Andrea^f | Forgione, Luigi^g | Giacummo, Attilio^h | Lacava, Roberto^a | Marino, Saverioⁱ | Simone, Maurizioⁱ | Zurlo, Amedeo^j | Putignano, Salvatore^k

Affiliations: [a] Elderly Health Care, Ambulatory Center for Dementia, ASP Catanzaro, Catanzaro, Italy | [b] A.G.E, Naples, Italy | [c] Ambulatory Center for Dementia, AUSL Modena, Modena, Italy | [d] ASL2 Turin, Turin, Italy | [e] DS 3 ASL Bitonto, Bari, Italy | [f] Director Dementia Care Program Mirandola District, AUSL Modena, Modena, Italy | [g] Elderly Assistance Unit, ASL NA 2, Naples, Italy | [h] Elderly Assistance Unit, DS 25 ASL NA1, Naples, Italy | [i] Elderly Assistance Unit, DS 53 Castellammare di Stabia, Naples, Italy | [j] Director O.U. of Geriatrics, University Hospital of Ferrara, Ferrara, Italy | [k] Elderly Assistance Unit, Center for Dementia, DS 30 ASL NA1, Naples, Italy

Correspondence: [*] Correspondence to: Pietro Gareri, MD, PhD; Elderly Health Care, Ambulatory Center for Dementia, ASP Catanzaro, Via Acri, 88100 Catanzaro, Italy. Tel.: +39 09 6170 36788; Fax: +39 09 6172 5095; E-mail: pietro.gareri@alice.it.

Abstract: Background:Combined therapy of memantine and acetylcholinesterase inhibitors (AChEIs) in patients with Alzheimer’s disease (AD) may be associated with higher benefits than either monotherapy. Objective:This retrospective multicentric study conducted in seven Italian Ambulatory Centers for Dementia assessed the efficacy and safety of memantine 20 mg/day administered for 6 months in addition to an AChEI in AD patients with worsened cognitive functions and behavioral disorders. Methods:A total number of 240 patients (61.7% of women, 38.3% men, mean age 77.9 ± 7.32 years old) who had started treatment with the combination therapy were recruited. At baseline (T0), Month 3 (T1), and Month 6 (T2), cognitive functions were assessed by Mini-Mental State Examination (MMSE), functional dependence by activities of daily living (ADL) and instrumental ADL, behavioral disturbances by the Neuropsychiatric Inventory (NPI), and comorbidities by Cumulative Illness Rating Scale. Adverse events were reported during the study. Results:MMSE total score significantly increased at Month 6 (p = 0.029 versus month 3) and IADL total score significantly decreased from baseline to endpoint (p = 0.033). There were no significant changes from baseline in mean ADL, despite significant improvements in NPI total score. The mean MMSE total score significantly increased with the combination donepezil + memantine compared to rivastigmine + memantine. The adverse events profile was in line with the expected range of the drugs studied and concomitant therapies. Overall, 17 patients discontinued treatment in the observation time. Conclusion:Combined treatment with memantine and AChEIs was effective in patients with AD, particularly in slowing cognitive impairment and preventing the onset of agitation and aggression in elderly AD patients.

Keywords: Alzheimer's disease, acetylcholinesterase inhibitor drugs, elderly, memantine

DOI: 10.3233/JAD-132735

Journal: Journal of Alzheimer's Disease, vol. 41, no. 2, pp. 633-640, 2014