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Comparative Study
. 2009 Jun;80(6):600-7.
doi: 10.1136/jnnp.2008.158964. Epub 2009 Feb 9.

Long-term effects of the concomitant use of memantine with cholinesterase inhibition in Alzheimer disease

O L Lopez  1 , J T Becker, A S Wahed, J Saxton, R A Sweet, D A Wolk, W Klunk, S T Dekosky
Affiliations
Comparative Study

Long-term effects of the concomitant use of memantine with cholinesterase inhibition in Alzheimer disease

O L Lopez et al. J Neurol Neurosurg Psychiatry. 2009 Jun.

Erratum in

  • J Neurol Neurosurg Psychiatry. 2009 Sep 1;80(9):1056

Abstract

Background: Patients using cholinesterase inhibitors (ChEIs) have a delay in nursing home (NH) admission compared with those who were not using the medication. There are no long-term studies of the effects of memantine in combination with ChEIs use in Alzheimer disease (AD). This study was conducted to examine the effects of ChEIs and memantine on time to death and time to NH admission.

Methods: Time to NH admission and death was examined in 943 probable AD patients who had at least a 1-year follow-up evaluation. Of these patients, 140 (14.9%) used both ChEIs and memantine, 387 (41%) [corrected] used only ChEIs, and 416 (44.1%) [corrected] used neither. The mean (SD) follow-up time was 62.3 (35.8) months. The analysis was conducted with multivariable Cox proportional hazard models controlling for critical covariates (ie, age, education level, gender, severity of the dementia, hypertension, diabetes mellitus, heart disease, psychiatric symptoms and use of psychotropic medications).

Results: Compared with those who never used cognitive enhancers, patients who used ChEIs had a significant delay in NH admission (HR: 0.37, 95% CI 0.27 to 0.49); this effect was significantly augmented with the addition of memantine (HR: 0.29, 95% CI 0.11 to 0.72) (memantine+ChEI vs ChEI alone). ChEIs alone, or in combination with memantine had no significant association on time to death.

Conclusions: This observational study revealed that the addition of the NMDA receptor antagonist memantine to the treatment of AD with ChEI significantly altered the treated history of AD by extending time to nursing home admission.

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Figures

Figure 1
Figure 1
Flow chart of the patients examined from 1983 to 2004, and the number of patients in each cohort. AD, Alzheimer disease; ChEIs, cholinesterase inhibitors.
Figure 2
Figure 2
Time to nursing home admission in Cohort 1. ChEIs, cholinesterase inhibitors.
Figure 3
Figure 3
Time to nursing home admission in Cohort 2. ChEIs, cholinesterase inhibitors.
See this image and copyright information in PMC

References

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