A review of the effects of memantine on clinical progression in Alzheimer's disease

Abstract

As Alzheimer's disease (AD) progresses, patients become increasingly dependent on others, placing a substantial impact on the daily lives of patients and caregivers. A treatment that slows clinical progression is a realistic and meaningful therapeutic goal for patients and caregivers. If given early, such a treatment would be expected to maximise any potential benefit. Memantine has shown clinical benefits in the key domains of AD, both as monotherapy and in combination with a cholinesterase inhibitor (ChEI). Memantine now has a considerable database of published studies and is associated with benefits in aspects of behaviour, cognition and communication, and on clinical progression. The results of these clinical studies are reviewed. Short-term clinical studies (≤28 weeks) have shown that memantine reduces clinical worsening and has also demonstrated positive effects in aspects of cognition--language, memory, praxis, functional communication--and in activities of daily living. Furthermore, memantine has been shown to reduce the rate of emergence of troublesome behaviour in patients with AD who were asymptomatic at baseline. Long-term follow-up studies (>1 year) have shown that the benefits of memantine are sustained and increase over time, and that memantine can delay nursing home placement in patients with AD. These findings provide evidence for the benefits of memantine, either alone or in combination with a ChEI, in slowing clinical progression in AD, and indicate that early treatment initiation may maximise clinical success. The benefits of memantine increase over time, allowing patients to remain independent for longer, alleviating caregiver burden and delaying institutionalisation.