OBJECTIVES: Data were extracted, pooled where possible, and weighted mean differences, standardized mean differences or odds ratios were estimated. Intention-to-treat (ITT) and observed cases (OC) analyses are reported, where data were available.
MAIN RESULTS: Effect of
memantine in patients with moderate to severe
Alzheimer's disease: analysis of the change from baseline at 28 weeks gave statistically significant results in favour of
memantine for 20 mg/day on cognition (MD: 6.1. 95% CI 2.99 to 9.21, P=0.0001)
activities of daily living (MD 2.10, 95% CI 0.46 to 3.74, p=0.01) and in the global clinical impression of change measured by the CIBIC-Plus at 28 weeks (MD -0.30, 95% CI -0.58 to -0.02, p=0.04), in all cases the analysis was the ITT-LOCF population (Reisberg 2000). There were no significant differences between
memantine and placebo for the number of drop-outs and total number of adverse effects, but a significant difference in favour of
memantine for the number who suffer agitation. Effect of
memantine in patients with mild to moderate
vascular dementia: analysis of the change from baseline at 28 weeks gave statistically significant results in favour of
memantine ( 20 mg/day ) for cognition (MD -2.19, 95% CI -3.16 to -1.21, P<0.0001) but there was no benefit for the clinical impression of change, or for global measures of
dementia (MMM300, and MMM500). There were no significant differences between
memantine and placebo for the number of drop-outs and total number of adverse effects, but a significant difference in favour of
memantine for the number who suffer agitation. Effect of
memantine in patients with
Alzheimer's disease and
vascular dementia at 12 weeks: there was no statistically significant difference between
memantine (10 mg/day) and placebo in
activities of daily living. There was a benefit in favour of
memantine (10 mg/day) compared with placebo at 12 weeks, for the numbers improved in terms of clinical impression of change (60/82 compared with 38/84 - OR 3.30, 95% CI 1.72 to 6.33, P=0.0003) (Winblad 1999). Effect of
memantine in patients with
vascular dementia,
Alzheimer's disease and
dementia of non-specified type at 6 weeks: there were beneficial effects on cognition (Ditzler 1991),
activities of daily living (Ditzler 1991, Pantev 1993), behaviour (Pantev 1993) and global scales (Gortelmeyer 1992; Pantev 1993; Ditzler 1991) and in global impression of change (Gortelmeyer 1992; Ditzler 1991). There were no significant differences between
memantine and placebo for the number of drop-outs and total number of adverse effects, but a significant difference in favour of placebo for the number who suffer
restlessness.
REVIEWER'S CONCLUSIONS: There is a beneficial effect of
memantine (20 mg/day) for patients with moderate to severe
Alzheimer disease on cognition and functional decline but not in the clinical impression of change. Patifor patients with moderate to severe
Alzheimer disease on cognition and functional decline but not in the clinical impression of change. Patients with mild to moderate
vascular dementia receiving
memantine 20 mg/day had less cognitive deterioration at 28 weeks but again this effect was not clinically discernible. There is a possible beneficial effect on cognition, function and global scales for
memantine at 6 weeks in mixed populations. The
drug is well tolerated and the incidence of adverse effects is low. More studies are needed.