Efficacy of memantine on behavioral and psychological symptoms related to dementia: a systematic meta-analysis

Ian D Maidment, Chris G. Fox, Malaz Boustani, Jorge Rodriguez, Ruth C. Brown, Cornelius L. Katona

Research output: Contribution to journalArticle

Abstract

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.
LanguageEnglish
Pages32-38
Number of pages7
JournalAnnals of Pharmacotherapy
Volume42
Issue number1
Early online date4 Dec 2007
DOIs
Publication statusPublished - Jan 2009

Fingerprint

Memantine
Behavioral Symptoms
Dementia
Meta-Analysis
Psychology
Equipment and Supplies
Placebos
Double-Blind Method
MEDLINE
Alzheimer Disease
Research Personnel
Therapeutics

Keywords

  • aged
  • Alzheimer disease
  • behavioral symptoms
  • dementia
  • excitatory amino acid antagonists
  • female
  • humans
  • male
  • memantine
  • statistical models
  • psychiatric status rating scales
  • randomized controlled trials as topic

Cite this

Maidment, Ian D ; Fox, Chris G. ; Boustani, Malaz ; Rodriguez, Jorge ; Brown, Ruth C. ; Katona, Cornelius L. / Efficacy of memantine on behavioral and psychological symptoms related to dementia : a systematic meta-analysis. In: Annals of Pharmacotherapy. 2009 ; Vol. 42, No. 1. pp. 32-38.
@article{4b6f739b0daf4e1a9fc1896497d09d3b,
title = "Efficacy of memantine on behavioral and psychological symptoms related to dementia: a systematic meta-analysis",
abstract = "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.",
keywords = "aged, Alzheimer disease, behavioral symptoms, dementia, excitatory amino acid antagonists, female, humans, male, memantine, statistical models, psychiatric status rating scales, randomized controlled trials as topic",
author = "Maidment, {Ian D} and Fox, {Chris G.} and Malaz Boustani and Jorge Rodriguez and Brown, {Ruth C.} and Katona, {Cornelius L.}",
year = "2009",
month = "1",
doi = "10.1345/aph.1K372",
language = "English",
volume = "42",
pages = "32--38",
journal = "Annals of Pharmacotherapy",
issn = "1060-0280",
publisher = "Harvey Whitney Books Company",
number = "1",

}

Efficacy of memantine on behavioral and psychological symptoms related to dementia : a systematic meta-analysis. / Maidment, Ian D; Fox, Chris G.; Boustani, Malaz; Rodriguez, Jorge; Brown, Ruth C.; Katona, Cornelius L.

In: Annals of Pharmacotherapy, Vol. 42, No. 1, 01.2009, p. 32-38.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Efficacy of memantine on behavioral and psychological symptoms related to dementia

T2 - Annals of Pharmacotherapy

AU - Maidment, Ian D

AU - Fox, Chris G.

AU - Boustani, Malaz

AU - Rodriguez, Jorge

AU - Brown, Ruth C.

AU - Katona, Cornelius L.

PY - 2009/1

Y1 - 2009/1

N2 - 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.

AB - 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.

KW - aged

KW - Alzheimer disease

KW - behavioral symptoms

KW - dementia

KW - excitatory amino acid antagonists

KW - female

KW - humans

KW - male

KW - memantine

KW - statistical models

KW - psychiatric status rating scales

KW - randomized controlled trials as topic

UR - http://www.scopus.com/inward/record.url?scp=38049005871&partnerID=8YFLogxK

U2 - 10.1345/aph.1K372

DO - 10.1345/aph.1K372

M3 - Article

VL - 42

SP - 32

EP - 38

JO - Annals of Pharmacotherapy

JF - Annals of Pharmacotherapy

SN - 1060-0280

IS - 1

ER -