title: Clinically meaningful treatment responses after switching to galantamine and with addition of memantine in patients with Alzheimer's disease receiving donepezil.
abstract: Clinical trials have shown the benefits of acetylcholinesterase inhibitors, such as donepezil and galantamine, and an N-methyl-D-aspartate receptor antagonist, memantine, in patients with Alzheimer's disease (AD). However, little is known regarding the effects of switching from donepezil 5 mg/day to galantamine 16 or 24 mg/day, or regarding the effects of adding memantine to established therapy compared with increasing the dose of donepezil. This report discusses two studies conducted to evaluate treatment with galantamine and memantine with respect to cognitive benefits and caregiver evaluations in patients with AD receiving donepezil 5 mg/day for more than 6 months. Patients with mild or moderate AD (scores 10-22 on the Mini-Mental State Examination) were enrolled in the Galantamine Switch study and switched to galantamine (maximum doses 16 mg versus 24 mg). Patients with moderate to severe AD (Mini-Mental State Examination scores 3-14) were enrolled in the Donepezil Increase versus Additional Memantine study and either had their donepezil dose increased to 10 mg/day or memantine 20 mg/day added to their existing donepezil dose. Patients received the study treatment for 28 weeks and their Disability Assessment for Dementia, Mental Function Impairment Scale, Cohen-Mansfield Agitation Inventory, and Neuropsychiatric Inventory scores were assessed with assistance from their caregivers. For the Galantamine Switch study after 8 weeks, agitation evaluated by the Cohen-Mansfield Agitation Inventory improved in both the 16 mg and 24 mg groups compared with baseline. However, there were no significant differences between the two galantamine groups. Agitation was also less in patients in the additional memantine group than in the donepezil increase group. In summary, switching to galantamine from donepezil and addition of memantine in patients with AD receiving donepezil were both safe and meaningful treatment options, and particularly efficacious for suppression of agitation.
authors: Department of Neurology, Toho University Omori Medical Center, Tokyo, Japan.
authors: Osamu
authors: O
authors: Kano
authors: Hirono
authors: H
authors: Ito
authors: Takanori
authors: T
authors: Takazawa
authors: Yuji
authors: Y
authors: Kawase
authors: Kiyoko
authors: K
authors: Murata
authors: Konosuke
authors: K
authors: Iwamoto
authors: Tetsuro
authors: T
authors: Nagaoka
authors: Takehisa
authors: T
authors: Hirayama
authors: Ken
authors: K
authors: Miura
authors: Riya
authors: R
authors: Nagata
authors: Tetsuhito
authors: T
authors: Kiyozuka
authors: Jo
authors: J
authors: Aoyagi
authors: Ryuta
authors: R
authors: Sato
authors: Teruo
authors: T
authors: Eguchi
authors: Ken
authors: K
authors: Ikeda
authors: Yasuo
authors: Y
authors: Iwasaki
keywords: Alzheimer’s disease; acetylcholinesterase inhibitors; agitation; donepezil; galantamine; memantine