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While memantine has received conditional
approval in Canada for the treatment of moderate-to-severe AD,
there has been no published data on its use in mild-to-moderate
disease. In a well-designed RCT with 403 AD patients with MMSE
scores of 10-22, memantine demonstrated significantly better
efficacy than placebo on measures of cognition, behaviour, and
clinical global impression, but no differences with respect
to activities of daily living.
Memantine treatment in mild to moderate
Alzheimer disease:
a 24-week randomized, controlled trial
(AM J GERIATR PSYCHIATRY 2006;14:704-715)
ELAINE R. PESKIND, MD,
STEVEN G. POTKIN, MD,
NUNZIO POMARA, MD,
BRIAN R. OTT, MD,
ET AL
for the MEMANTINE
MEM-MD-10 STUDY GROUP,
irvin e, ca,
seattle, wa,
jersey city, nj
ATYPICAL ANTIPSYCHOTICS: CONCERNS
ABOUT
EFFICACY AND SAFETY
Concerns about the efficacy and safety
of atypical antipsychotics for the treatment of neuropsychiatric
symptoms of dementia persist. In a large NIMH RCT effectiveness
study in AD outpatients, there was no difference compared to placebo
for olanzapine, risperidone, and quetiapine on the primary outcome
measure which was time to discontinuation of treatment for any
reason (Schneider et al, 2006). These results contrast
with a number of other RCTs, which suggested that risperidone
and olanzapine are effective in institutionalized dementia patients.
The major potential adverse effects of atypical antipsychotics
are reviewed by Herrmann and Lanctôt (2006) who conclude
that while significant safety concerns do exist, atypical antipsychotics
are still better choices than typical antipsychotics and individual
patient characteristics must be taken into account when weighing
risks and benefits.
Effectiveness of atypical antipsychotic
drugs in patients with Alzheimer’s disease
(N ENGL J MED 2006;355(15):1525-1538)
LON S. SCHNEIDER, MD,
PIERRE N. TARIOT, MD,
KAREN S. DAGERMAN, MS,
SONIA M. DAVIS, DrPH
ET AL
for the CAT IE-AD STUDY GROUP,
various centres, USA
Atypical antipsychotics for neuropsychiatric
symptoms of dementia: malignant or maligned?
(DRUG SAF 2006:29(10):833-43)
NATHAN HERRMANN,
KRISTA LANCTôT
TORONTO, on
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