Memantine enhances autonomy in moderate to severe Alzheimer's disease.
BACKGROUND
Alzheimer's disease (AD) is the leading cause of dementia and its course renders patients functionally disabled. Memantine is the first drug to demonstrate a clinical benefit in the treatment of patients with moderately-severe to severe AD.


OBJECTIVE
Our objective was to illustrate the benefits of memantine on functional disability.


METHODS
We classified 252 patients from a randomised 28-week clinical trial of memantine vs placebo according to their Activities of Daily Living capabilities measured by the ADCS-ADLsev scale. The scale was divided into two sub-scores: basic and instrumental. The relevance of this classification was validated by comparing clinical and socio-demographic parameters between the different autonomy classes (autonomous and dependent). The effect of memantine was estimated by using a logistic regression model on the autonomy status of patients at week 28, controlling for confounding factors (Observed Cases analysis).


RESULTS
Our results showed that dependent patients (n = 106) had significantly longer disease duration, poorer cognition, greater severity, more behavioural alterations and higher total societal costs compared with autonomous patients (n = 146). When controlling for autonomy and severity at baseline, memantine-treated patients were three times more likely [Odds Ratio (OR) = 3.03; 95% Confidence Intervals (CI) = (1.38, 6.66)] to remain autonomous after 28 weeks. Analysis of the Treated Per Protocol set and the use of Last Observation Carried Forward analyses confirmed this finding.


CONCLUSIONS
Memantine enhances autonomy in patients with moderately-severe to severe AD by increasing the probability of their remaining autonomous, therefore delaying transition to the dependent stage.
Rive
Benoît
B
Altipharm SA, 15 rue du Louvre, 75001 Paris, France. benoit_rive@hotmail.com
Vercelletto
Martine
M
Damier
Florence Delamarre
FD
Cochran
John
J
François
Clément
C
D000203:Activities of Daily Living; D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000534:rehabilitation; D004311:Double-Blind Method; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008559:Memantine / Q000627:therapeutic use*; D026684:Personal Autonomy
D018691:Excitatory Amino Acid Antagonists; D008559:Memantine