Clinical Experience of Memantine in Alzheimer’s Disease

Clinical Experience of Memantine in Alzheimer’s Disease

Blesa Rafael
Published: European Neurology - Volume 3 Issue 2
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Alzheimer’s disease (AD) is a progressive neurodegenerative condition characterised by increasing cognitive, functional and behavioural deficits. Patients with AD suffer continuous progressive memory loss, disorientation, intellectual deterioration, impairment of language skills, declining judgement, agitation and psychosis. Indeed, intellectual deterioration with cognitive dysfunction and behavioural disturbances are major features of disease progression.1 As AD becomes more advanced, symptoms such as severely impaired recent and remote recall, receptive and expressive aphasia and terminal mutism are common. The deterioration of mental health in AD patients can be rapid and without remission, and can include rare periods of arrested progression.2 As the mean age of the worldwide population continues to increase, the number of people affected by AD is growing. At least 15 million people have been estimated to have AD globally,3 including 4.5 million patients in the US4 and 4.7 million cases in Europe in 2000.5 Approximately 0.3–1% of individuals between 60 and 64 years of age are affected by AD, and this proportion rises to 42–68% in individuals ≥95 years of age.6 Epidemiological studies suggest that 60–70% of all dementia cases are AD5,7 and approximately 30% of AD patients have severe disease.8

There is a wide variation in the rate of disease progression in patients with AD, although cognitive deterioration is always persistent and continuous. The progressive deterioration includes the loss of unctional capacity over time, resulting in an inability to perform basic activities of daily living (ADL). Thus, loss of independence is one of the most important and inevitable consequences of AD,9 placing a substantial economic and emotional burden on care-givers and healthcare providers.10 The considerable burden of AD, compounded by the lack of remission and constant deterioration over many years, means that it is an extremely challenging disease for patients, care-givers and society as a whole. As the symptoms associated with AD are relatively mild during its earlier stages, the disease is most commonly diagnosed at an intermediate to late stage of progression. Patients with moderate to severe AD at diagnosis have typically already experienced appreciable losses in cognition and functioning. However, such patients may still benefit greatly from the use of the N-methyl-D-aspartate (NMDA) receptor antagonist memantine (Ebixa®/Namenda®/Axura®). Memantine is the first of this new class of uncompetitive NMDA receptor antagonists and is the only treatment currently approved for moderate to severe AD. Memantine blocks the effects of glutamate, reducing the glutamatergic overstimulation that may result in neuronal damage (excitotoxicity) and lead to the pathogenesis of AD.11–13 Indeed, pivotal studies with memantine have demonstrated its efficacy in terms of the global, functional, behavioural and cognitive components of AD-related decline.14–17 Randomised clinical trial data also suggest that memantine has an overall and meaningful benefit on ADL. These results are further supported by including open-label extension studies18 and studies investigating combination therapy with acetylcholinesterase inhibitors (AChEI), which appear to demonstrate increased cognitive benefits relative to AChEI monotherapy.16,19 Memantine has also shown an effect of delaying clinical worsening in moderate to severe AD patients.20 Thus, memantine offers hope to AD patients and their carers for greater independence and an improved quality of life (QoL).

The true usefulness of any treatment is determined by how the agent performs in everyday clinical practice, how a patient feels and functions subjectively during treatment with the agent and how willing a patient is to comply with the prescribed medication.21 Case studies offer the practical perspective and personal insight into ‘real-life’ treatment experiences that are difficult to capture in controlled clinical studies.22 Thus, this article includes four case studies (each focusing on a different component of AD-related decline) that illustrate the usefulness of memantine in clinical practice for both patients and carers.

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