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NEUROLOGY

Efficacy of Memantine on Behavioral and Psychological Symptoms Related to Dementia: A Systematic Meta-Analysis

Senior Pharmacist, Kent & Medway NHS and Social Care Partnership Trust; Honorary Senior Lecturer, Kent Institute of Medicine and Health Studies, University of Kent, Kent, England

Chris G Fox, MB BS

Consultant Psychiatrist, Kent & Medway NHS and Social Care Partnership Trust; Honorary Senior Lecturer, Kent Institute of Medicine and Health Studies, University of Kent

Malaz Boustani, MD PhD

Research Scientist, Regenstrief Institute; Assistant Professor of Medicine, Indiana University School of Medicine; Center Scientist, Indiana University Center for Aging Research, Indianapolis, IN

Jorge Rodriguez, PhD

Senior Lecturer, Centre for Health Services Studies, University of Kent

Ruth C Brown, BPharm

Clinical Pharmacist, Kent & Medway NHS and Social Care Partnership Trust

Cornelius L Katona, MD PhD

Consultant Psychiatrist, Kent & Medway NHS and Social Care Partnership Trust; Dean, Kent Institute of Medicine and Health Studies, University of Kent

Reprints: Mr. Maidment, St. Martin's Hospital, Littlebourne Rd., Canterbury, Kent, CT1 1AZ, UK, fax 01227 812389, ian.maidment{at}nhs.net

BACKGROUND: The behavioral and psychological symptoms related to dementia (BPSD) are difficult to manage and are associated with adverse patient outcomes.

OBJECTIVE: To systematically analyze the data on memantine in the treatment of BPSD.

METHODS: We searched MEDLINE, EMBASE, Pharm-line, the Cochrane Centre Collaboration, www.clinicaltrials.gov, www.controlled-trials.com, and PsycINFO (1966-July 2007). We contacted manufacturers and scrutinized the reference sections of articles identified in our search for further references, including conference proceedings. Two researchers (IM and CF) independently reviewed all studies identified by the search strategy. We included 6 randomized, parallel-group, double-blind studies that rated BPSD with the Neuropsychiatric Inventory (NPI) in our meta-analysis. Patients had probable Alzheimer's disease and received treatment with memantine for at least one month. Overall efficacy of memantine on the NPI was established with a t-test for the average difference between means across studies, using a random effects model.

RESULTS: Five of the 6 studies identified had NPI outcome data. In these 5 studies, 868 patients were treated with memantine and 882 patients were treated with placebo. Patients on memantine improved by 1.99 on the NPI scale (95% Cl -0.08 to -3.91; p = 0.041) compared with the placebo group.

CONCLUSIONS: Initial data appear to indicate that memantine decreases NPI scores and may have a role in managing BPSD. However, there are a number of limitations with the current data; the effect size was relatively small, and whether memantine produces significant clinical benefit is not clear.

Key Words: Alzheimer's disease, dementia, memantine

Published Online, December 4, 2007. www.theannals.com, DOI 10.1345/aph.1K372