Memantine for dementia

McShane, Rupert; Westby, Maggie J; Roberts, Emmert; Minakaran, Neda; Schneider, Lon S.; Farrimond, Lucy; Maayan, Nicola; Ware, Jennifer; Debarros, Jean

doi:10.1002/14651858.cd003154.pub6

Cited by 240 publications

(221 citation statements)

References 191 publications

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“…В другом Кокрейновском обзоре (44 исследова ния, около 10 000 испытуемых) [16], было показа но, что у пациентов, принимавших мемантин, реже развивалась ажитация: отношение рисков (ОР) 0,81 (95 % ДИ 0,66-0,99; на 25 пациентов меньше на каждые 1000 больных (95 % ДИ 1-44)). Также представлены данные об ограниченной клиниче ской пользе мемантина для лечения ажитации, по лученные на основании результатов трех дополни тельных исследований.…”

Section: частота и степень выраженности нежелательных реакций вызванunclassified

“…опросника КогенМансфилд для оценки возбуж дения (CohenMansfield Agitation Inventory, CMAI) клиническая польза применения мемантина -0,50 баллов по CMAI, 95 % ДИ 3,71-4,71 [16].…”

Section: частота и степень выраженности нежелательных реакций вызванunclassified

“…Несмотря на то, что прекра щение приема ингибиторов холинэстеразы и/или мемантина может привести к ухудшению когни тивных функций у определенных групп пациентов, доступные для анализа научные данные о клини чески значимых конечных точках (качество жизни, сохранение функций) позволяют предположить, что прекращение приема препаратов не может суще ственно повлиять на результаты. Отмечается также, что как назначение, так и депрескрайбинг противо дементных препаратов имеют множество нюансов, требующих дальнейшего изучения и уточнения воз можностей оптимизации фармакотерапии 16 .…”

Section: частота и степень выраженности нежелательных реакций вызванunclassified

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Safety of Cholinesterase Inhibitors and NMDA Receptors Antagonists for the Treatment of Patients with Dementia

Переверзев

Остроумова

Ткачева

et al. 2019

Bezopasnost' i risk farmakoterapii

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For the treatment of dementia and Alzheimer’s disease, acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) and/or the non-competitive inhibitor of N-methyl-D-aspartate receptors (NMDA receptors) memantine are currently used. The administration of these drugs can help temporarily improve or stabilize memory impairments and other cognitive functions, regress behavioral disorders, reduce the patient’s dependence on others, but at the same time can lead to the development of adverse drug reactions. The aim of this study was to analyze the information on the safety of acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) and the non-competitive inhibitor of NMDA receptors used to treat dementia. It was shown that stimulation of cholinergic receptors can lead to adverse drug reactions as contraction and narrowing of the pupil (miosis), an increase in lens curvature, accommodation spasm (visual impairment and an increased risk of falls), a decrease in heart rate (bradycardia) and inhibition of conduction of impulses through the conducting system heart, increased tone of the bronchi, gastrointestinal tract, gall and bladder, decreased tone of the sphincters of the digestive tract and bladder, increased secretion of exocrine and glands of the stomach, agitation, confusion. Blockade of NMDA receptors due to impairment of glutamate metabolism in the central nervous system may be the cause of neurotoxicity of NMDA receptor antagonists, and also causes dizziness, feeling of tiredness, hallucinations, drowsiness, and confusion. In case of development of adverse reactions, if possible, it is necessary to stop using the drug or reduce its dose, in case of an overdose or other need, prescribe symptomatic therapy. Information on the safety of cholinesterase inhibitors and NMDA receptor antagonists presented in the article is of practical importance for healthcare professionals, as it allows them to assess the possible risks associated with the use of drugs of these groups more accurately. In addition, the information can be used to optimize and individualize the pharmacotherapy regimens for patients with dementia, including the development of domestic protocols for the deprescribing of drugs (evidence-based practice of withdrawal, replacement or gradual dose reduction) in the elderly.

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Section: частота и степень выраженности нежелательных реакций вызванunclassified

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Safety of Cholinesterase Inhibitors and NMDA Receptors Antagonists for the Treatment of Patients with Dementia

Переверзев

Остроумова

Ткачева

et al. 2019

Bezopasnost' i risk farmakoterapii

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“…Одной из новейших работ, посвященных этому препарату, является Кокрейновский метаанализ, опубликованный в 2019 г. [52]. В нем изучались эффективность и безопасность акатинола мемантина при деменции, а также потенциальная польза его добавления в схему лечения у пациентов, уже принимающих ингибиторы ацетилхолинэстеразы.…”

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“…При сосудистой деменции легкой и средней степени тяжести в Кокрейновском метаанализе 2019 г. [52] (2 исследования, n=750) выявлено положительное влияние акатинола мемантина по сравнению с плацебо на когнитивные функции -различия в 2,15 балла по шкале ADAS-Cog (95% ДИ 1,05-3,25), а также на поведение и настроение -различия в 0,47 балла по нарушениям поведения по шкале NOS-GER (Nurses' Observation Scale for Geriatric Patients -сестринская шкала наблюдения за гериатрическими пациентами; 95% ДИ 0,07-0,87). Особенно важно, что число пациентов, прервавших лечение, статистически значимо не различалось в группах акатинолола мемантина и плацебо (ОР 1,05; 95% ДИ 0,83-1,34), что указывает на высокую безопасность препарата.…”

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Vascular factors in the genesis of dementia and the optimization of patient management

Остроумова

Кочетков

2019

RJTAO

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The review considers the problem of cognitive impairment (CI) and dementia in patients from older age groups, as well as the safety of antidementia agents with a focus on adverse cardiovascular drug reactions. Special attention is paid to the role of cardiovascular risk factors in the genesis of CI and all types of dementia. It is emphasized that the treatment of patients with CI is primarily aimed at monitoring vascular risk factors, preventing stroke and progression of chronic cerebrovascular disease, and, therefore, improving cognitive functions. Postoperative cognitive dysfunction in elderly patients, in particular during coronary artery bypass surgery, is highlighted. Non-drug and drug measures to prevent the progression of CI and dementia are described in detail. The significant importance of multimorbidity and polypragmasia in elderly patients with dementia is noted; data on the cardiovascular safety of anti-dementia drugs are presented.

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Discontinuation of Cholinesterase Inhibitors Following Initiation of Memantine and Admission to Long-Term Care Among Older Adults

Lee,

Shi,

Sison

et al. 2024

JAMA Netw Open

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ImportanceDiscontinuing cholinesterase inhibitors when initiating memantine in patients with dementia may be reasonable to reduce treatment burden, costs, and the risk of adverse drug events.ObjectiveTo assess the association of cholinesterase inhibitor discontinuation on long-term care institutionalization among older adults with dementia who initiate memantine.Design, Setting, and ParticipantsThis retrospective propensity score-matched cohort study used Medicare claims data from January 2014 to December 2019. Participants included fee-for-service Medicare beneficiaries with dementia. Data were analyzed from September 2021 to August 2024.ExposuresDiscontinuation vs continuation of cholinesterase inhibitor.Main Outcomes and MeasuresThe primary outcome was 1-year long-term care institutionalization-free days. Secondary outcomes include all-cause death and adverse drug events over 1 year. We performed subgroup analyses based on age, sex, dementia type (Alzheimer disease vs other), frailty, and dementia severity (mild vs moderate or severe) based on claims-based algorithms. The primary outcome was analyzed using nonparametric restricted mean survival time analysis.ResultsAmong 16 292 beneficiaries who initiated memantine, 1820 (11.2%) discontinued cholinesterase inhibitors. In the propensity score-matched cohort of 3612 beneficiaries, the mean (SD) age was 80.7 (6.7) years, 2261 (62.6%) were female, and 1989 (55.0%) had a diagnosis of Alzheimer disease. Over 1 year, long-term care institutionalization occurred in 51 of 1806 beneficiaries (2.8%) who discontinued cholinesterase inhibitors (3.4 per 100 person-years) and 62 of 1806 beneficiaries (3.4%) who continued (4.1 per 100 person-years). There was no statistically significant difference in the 1-year mean institutionalization-free days between discontinuation and continuation groups (360.6 [95% CI, 359.3 to 362.0] days vs 359.1 [95% CI, 357.5 to 360.6] days; mean difference, 1.5 [95% CI,−0.5 to 3.6] days). The mean difference in the long-term care institutionalization-free days did not differ by age category, sex, dementia type, frailty, or dementia stage. Individuals who discontinued had a lower rate of fall-related injury (0.9 vs 2.0 per 100 person-years; hazard ratio [HR], 0.47 [95% CI, 0.25 to 0.88]). There was no difference between the discontinuation and continuation groups in all-cause death (10.4 vs 11.6 per 100 person-years; HR, 0.89 [95% CI, 0.72 to 1.10]).Conclusions and RelevanceIn this study, discontinuing cholinesterase inhibitors upon memantine initiation was not associated with an increased risk of long-term care institutionalization but with a lower risk of fall-related injury among older adults with dementia. These findings offer valuable insights for clinicians aiming to reduce treatment burden in this population.

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Memantine for dementia

Cited by 240 publications

References 191 publications

Safety of Cholinesterase Inhibitors and NMDA Receptors Antagonists for the Treatment of Patients with Dementia

Safety of Cholinesterase Inhibitors and NMDA Receptors Antagonists for the Treatment of Patients with Dementia

Vascular factors in the genesis of dementia and the optimization of patient management

Discontinuation of Cholinesterase Inhibitors Following Initiation of Memantine and Admission to Long-Term Care Among Older Adults

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