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Memantine
- 1. Cognitive Enhancers Role of memantine
- 10. Dementia – site classification
- 16. Cholinesterase inhibitors The types & MOA
- 24. Alzheimer’s disease The basics
- 31. Memantine Understanding in depth
- 35. Memantine - MOA
- 36. Memantine - MOA
- 53. Memantine in severe AD
- 54. Memantine + donezepil in severe AD
- 55. Memantine in Severe Dementia: Results of the M-Best Study Benefit and Efficacy in Severely Demented Patients During Treatment With Memantine
- 56. Study Design No. of patients N = 166 (nursing home) Design Double-blind, randomized, placebo- controlled, multicenter study Diagnosis Primary dementia (AD, VaD, mixed types) Age 60 – 80 years (mean 68.4) Severity MMSE < 10 (mean 6.3), GDS 5 – 7 Dose; duration 10 mg memantine/day; 12 weeks Primary efficacy Global: CGI-C parameters Care Dependence: BGP subscore Secondary efficacy Function/Behavior: D-Scale, BGP parameter Winblad and Poritis., Int J Geriat Psychiatr 1999
- 57. Memantine Improves Global Impression (CGI-C) Responders [%] in CGI-C ITT analysis, N = 166 Response = improvement * p = 0.006, ** p = 0.001 versus placebo Winblad and Poritis., Int J Geriat Psychiatr 1999 Week 4 Week 12 * ** 80 70 60 50 40 30 20 10 0 59% 40% 73% 45% Memantine Memantine Placebo Placebo
- 62. AD ahead
Notes de l'éditeur
- Source: World Alzheimer’s Report 2009
- Australian Medicines handbook
- Specific diseases
- Specific diseases
- Specific diseases
- Specific diseases
- Specific diseases
- Fundamentals of Psychopharmacology Bullock, Manais, Galbraith
- The primary efficacy variable Clinical Global Impression of Change (CGI-C) is a 7-point global rating, performed by an experienced clinician. The second primary efficacy parameter was the subscale “care dependence” of the Behavioral Rating Scale for Geriatric Patients (BGP), an observer-rated scale for the assessment of functional and behavioral disturbances of geriatric patients, and performed by the nursing staff. The secondary efficacy parameter D-Scale, an extended and validated version of the D-Test, is a 16-item, 6-point rating scale. It is a criterion for functional capabilities and remaining independence and was assessed by the nurse. This study investigated for the first time ever the clinical efficacy and tolerability of memantine in care-dependent severely demented inpatients. Due to the elderly, fragile population the study period was 3 months, and the trial medication 10 mg per day. Patients with Alzheimer’s disease, vascular dementia or mixed forms were included. Investigational focus was on functional disability status and care dependence.
- The Clinical Global Impression of Change (CGI-C) is a 7-point global rating, performed by an experienced clinician. The three CGI-C-categories of improvement were defined as response, while “no change” and the three categories of worsening were defined as non-response. The assessment of change was conducted by the same clinician who had also rated the patients condition at baseline. This slide shows the percentage of improved patients after 4 and 12 weeks of treatment with either memantine (10 mg/day) or placebo. The data analysis is based on the intent-to-treat (ITT) population, discontinuations were replaced by worst cases. Significantly more patients receiving memantine improved in their clinical global impression during the course of the study in comparison to the placebo group. Interestingly, the significant effect in favor of memantine was already seen after only four weeks; at the end of the study the difference in response was even more pronounced. Placebo treated patients showed a surprisingly high responder rate. This might be due to the fact that patients taking part in a clinical study are intensively cared for.
- The positive results of the M-Best study have been the starting point for further investigation of memantine for the treatment of advanced dementia. These findings supported the approval of memantine as the first drug ever for the treatment of moderately severe to severe Alzheimer’s disease in Europe and several other countries. This study showed that memantine is efficacious in severely demented patients suffering from probable Alzheimer’s disease or probable vascular dementia. In severely demented patients significant functional improvement and reduction of care dependence was observed in this study - a clear benefit for patient and nursing staff.