Domain-specific improvement of cognition on memantine in patients with Alzheimer's disease treated with rivastigmine.
OBJECTIVE
Cholinergic therapy is used in mild-to-moderate Alzheimer's disease (AD) and antiglutamatergic therapy in moderate-to-severe AD. Global scales, as commonly used in clinical trials, blur specifics of disease progression and drug effects. The objective was to assess combination therapy of rivastigmine plus memantine by specific neuropsychological tests in patients with mild-to-moderate AD.


METHODS
12-week-short multicenter open-label pilot study. Ninety patients with mild-to-moderate AD already on stable medication with rivastigmine (3-6 mg b.i.d.) additionally received memantine for 12 weeks. Subscales of the Alzheimer's Disease Assessment Scale (ADAS-cog), the Mini-Mental State Examination (MMSE) and additional neuropsychological tests (e.g. span tasks, semantic fluency) were assessed.


RESULTS
The scores in the ADAS-cog memory subscale, the MMSE score, and digit span and semantic fluency significantly improved on combination therapy.


CONCLUSIONS
Memory improvement was correlated with ADAS-cog memory score at baseline and inversely with age at onset of treatment. The data suggest that improvement on combination therapy results from an improvement of attention/executive function with secondary memory improvement, which will need to be confirmed in a subsequent double-blind study on a larger number of patients.
Riepe
Matthias W
MW
Department of Psychiatry, Charité Universitatsmedizin Berlin, Berlin, Germany. matthias.riepe@charite.de
Adler
Georg
G
Ibach
Bernd
B
Weinkauf
Birgit
B
Tracik
Ferenc
F
Gunay
Ibrahim
I
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000188:drug therapy*; D001288:Attention / Q000187:drug effects; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003071:Cognition / Q000187:drug effects*; D003072:Cognition Disorders / Q000188:drug therapy / Q000209:etiology; D004359:Drug Therapy, Combination; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008559:Memantine / Q000627:therapeutic use*; D008568:Memory / Q000187:drug effects; D048448:Phenylcarbamates / Q000627:therapeutic use*; D010865:Pilot Projects; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors; D000068836:Rivastigmine; D012720:Severity of Illness Index; D016896:Treatment Outcome
D002800:Cholinesterase Inhibitors; D018691:Excitatory Amino Acid Antagonists; D048448:Phenylcarbamates; D016194:Receptors, N-Methyl-D-Aspartate; D000068836:Rivastigmine; D008559:Memantine