title: Memantine and brain atrophy in Alzheimer's disease: a 1-year randomized controlled trial.
abstract: The primary objective of this study was to evaluate the rate of total brain atrophy (TBA) with serial magnetic resonance imaging (MRI), using the Brain Boundary Shift Integral (BBSI), in patients with probable Alzheimer's disease (AD) over the course of 52 weeks of treatment with memantine or placebo. This was a multi-national, randomized, double-blind, placebo-controlled, fixed-dose 1-year study. Patients were randomized (1 : 1) to treatment with placebo or memantine. Patients randomized to memantine were up-titrated to the target dose of 20 mg/day over 4 weeks. MRI scans were collected at screening and at Weeks 4, 42, and 52. Secondary efficacy assessments included several cognitive and behavioral scales. 518 patients were screened, 278 patients were randomized, and 217 patients completed the study. In the primary efficacy analysis, the differences in TBA rates between memantine (15.2 mL/year) and placebo (15.3 mL/year) were not statistically significant (-0.04 mL/year [(95% CI: -2.60, 2.52), p = 0.98]). There was a statistically significant correlation between change in TBA and change in most cognitive and behavioral scale scores. Patients who were not treated with acetyl cholinesterase inhibitors (AChEIs) showed a significantly lower TBA rate than patients treated with AChEIs. Memantine had a placebo-level incidence of adverse events. There were no statistically significant differences between memantine and placebo in total brain or hippocampal atrophy rates in patients with probable AD treated for 1 year. The biological relevance of cerebral atrophy was supported by a significant correlation between rate of atrophy and decline in cognitive and behavioral outcomes.
authors.affiliation: Memory Assessment and Research Centre, Moorgreen Hospital, Southampton, UK. David.Wilkinson@southernhealth.nhs.uk
authors.forename: David
authors.initials: D
authors.lastname: Wilkinson
authors.forename: Nick C
authors.initials: NC
authors.lastname: Fox
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
authors.forename: Ravinder
authors.initials: R
authors.lastname: Phul
authors.forename: Ole
authors.initials: O
authors.lastname: Lemming
authors.forename: Philip
authors.initials: P
authors.lastname: Scheltens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000473:pathology*; D000704:Analysis of Variance; D001284:Atrophy / Q000209:etiology / Q000473:pathology; D001921:Brain / Q000187:drug effects* / Q000473:pathology; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007391:International Cooperation; D008279:Magnetic Resonance Imaging; D008297:Male; D008559:Memantine / Q000494:pharmacology / Q000627:therapeutic use*; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors; D008559:Memantine