Treating Cognition and Function in Patients With Alzheimer Disease

By William E. Reichman, MD and Shailaja Shah, MD | April 1, 2006

Adverse effects with memantine(Drug information on memantine) are infrequent but can include headache, sedation, fatigue, constipation, increased confusion, irritability, and agitation.

The cost-effectiveness of AD treatments has been questioned. In the United Kingdom, the National Institute for Clinical Excellence has proposed the withdrawal of cholinesterase inhibitors and memantine from their National Health Service.¹¹ They suggested that there is insufficient evidence that the agents have measurable effects on quality of life and extension of time to admission to nursing home care. Until the next generation of therapeutics arrives, however, cholinesterase inhibitors and memantine will probably remain essential components of AD therapy for cognition and function (Table 2).

Dr Reichman is professor of psychiatry and neurology at the University of Medicine and Dentistry of New Jersey (UMDNJ)-Robert Wood Johnson Medical School, Piscataway, NJ. He reports that he is a consultant with the speaker’s bureaus at AstraZeneca, Forest Laboratories, Janssen, Novartis, Ortho- McNeil, and Pfizer.

Dr Shah is clinical assistant professor of psychiatry at UMDNJ-Robert Wood Johnson Medical School. She reports that she has no conflicts to report concerning the subject matter of this article.

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References
1. Cummings JL. Alzheimer’s disease. N Engl JMed. 2004;351:56-67.
2. Lyketsos CG, Steinberg M, Tschanz JT, et al. Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. Am J Psychiatry. 2000;157:708-714.
3. Doody RS, Stevens JC, Beck C, et al. Practice parameter: management of dementia (an evidencebased review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56:1154-1166.
4. Ritchie CW, Ames D, Clayton T, Lai R. Metaanalysis of randomized trials of the efficacy and safety of donepezil, galantamine, and rivastigmine for the treatment of Alzheimer disease. Am J Geriatr Psychiatry. 2004;12:358-369.
5. Winblad B, Engedal K, Soininen H, et al. A 1-year, randomized, placebo-controlled study of donepezil in patients with mild to moderate AD. Neurology. 2001;57:489-495.
6. Raskind MA, Peskind ER, Wessel T, Yuan W. Galantamine in AD: a 6-month randomized, placebocontrolled trial with a 6-month extension. The Galantamine USA-1 Study Group. Neurology. 2000;54: 2261-2276.
7. Rogers SL, Doody RS, Pratt RD, Ieni JR. Longterm efficacy and safety of donepezil in the treatment of Alzheimer’s disease: final analysis of a US multicentre open-label study. Eur Neuropsychopharmacol. 2000;10:195-203.
8. Reisberg B, Doody R, Stoffler A, et al. Memantine in moderate-to-severe Alzheimer’s disease. N Engl J Med. 2003;348:1333-1341.
9. Tariot PN, Farlow MR, Grossberg GT, et al. Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial. JAMA. 2004;291:317-324.
10. Winblad B, Poritis N. Memantine in severe dementia: results of the 9M-BEST Study (Benefit and efficacy in severely demented patients during treatment with memantine). Int J Geriatr Psychiatry. 1999;14:135-146.
11. Kmietowicz Z. NICE proposes to withdraw Alzheimer’s drugs from NHS. BMJ. 2005;330:495 [see erratum].

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Treating Cognition and Function in Patients With Alzheimer Disease

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