Efficacy of memantine on behavioral and psychological symptoms related to dementia: a systematic meta-analysis.
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.
Maidment
Ian D
ID
Kent & Medway NHS and Social Care Partnership Trust, Kent Institute of Medicine and Health Studies, University of Kent, Kent, England. ian.maidment@nhs.net
Fox
Chris G
CG
Boustani
Malaz
M
Rodriguez
Jorge
J
Brown
Ruth C
RC
Katona
Cornelius L
CL
D000368:Aged; D000544:Alzheimer Disease / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D001526:Behavioral Symptoms / Q000188:drug therapy; D003704:Dementia / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008559:Memantine / Q000627:therapeutic use*; D015233:Models, Statistical; D011569:Psychiatric Status Rating Scales; D016032:Randomized Controlled Trials as Topic
D018691:Excitatory Amino Acid Antagonists; D008559:Memantine