Memantine in Alzheimer's disease - results of an observational study in nursing home patients

Background: Alzheimer´s disease (AD) is common in nursing home residents. An effective treatment for those patients is of increasing interest, however available data of patients in a nursing home setting are limited. In this observational study the efficacy and tolerability of memantine, the only approved N-methyl-D-aspartate antagonist for the treatment of AD, were investigated. Methods: The observational period was 6 months. Patients with AD were treated according to routine clinical practice. Patients´ cognitive and functional abilities were evaluated using the Mini-Mental State Examination (MMSE) and the Functional Assessment Scale (FAST), respectively, at the beginning of the study, and at weeks 12 and 24. Furthermore, caregivers and physicians assessed the patients using the Nurses´ Observation Scale for Geriatric Patients (NOSGER) and the Clinical Global Impression of Change (CGIC). Tolerability measured using a 4-point scale and adverse events were evaluated. Statistical analysis was descriptive. Results: Data from 1325 patients (mean age 79 years) were analysed. After 6 months of treatment with memantine, the MMSE score showed improvement in 71% of patients and stabilisation in 9% of patients. Stabilisation or Improvement in functional abilities were assessed in most patients (59% and 30%, respectively). For 67% of patients improvement in NOSGER total score was evaluated as early as 4 weeks and the number of patients increased further during the observational period. The number of patients with reported agitation at the beginning of the study reduced over the 6 month period. The tolerability profile was assessed as very good (60%) and good (40%). Conclusions: The results of this study, conducted in a large population of nursing home residents with AD, show the efficacy of memantine on functional, cognitive and behavioural abilities and the excellent tolerability of memantine. The results of this observational study are in accordance with randomised controlled clinical studies.