Efficacy of memantine on neuropsychiatric symptoms associated with the severity of behavioral variant frontotemporal dementia: A six-month, open-label, self-controlled clinical trial

Abstract

Abstract. Previous studies have focused on the curative effects of memantine in patients with mild-to-moderate frontotemporal lobar degeneration (FTLD); however, its benefits in patients with moderate-to-severe FTLD have not been investigated. The present study explores the behavioral, cognitive and functional effects of memantine on behavioral variant frontotemporal dementia (bvFTD) in patients with mild and moderate-to-severe stage bvFTD. A total of 42 patients with bvFTD completed a 6-month treatment plan of 20 mg memantine daily in an open-label, self-controlled clinical trial. Patients were divided into two groups according to their Mini-Mental State Examination (MMSE) score: Mild (score, 21-26); and moderate-to-severe (score, 4-20). Primary endpoints included Neuropsychiatric Inventory Questionnaire (NPI-Q) and Clinic Dementia Rating (CDR) scores, and secondary endpoints comprised Neuropsychiatric Inventory Caregiver Distress Scale (NPI-D), MMSE, Montreal Cognitive Assessment (MoCA), Activity of Daily Life (ADL) and Hamilton Depression Rating Scale (HAMD) scores. Memantine treatment had no effect on overall NPI-Q scores, with the exception of the agitation subdomain in all patients with bvFTD. However, patients with moderate-to-severe bvFTD exhibited a better performance than patients with mild bvFTD, demonstrated by improved NPI-Q total scores and subscales of agitation, depression, apathy and disinhibition. In the moderate-to-severe group, CDR and HAMD scores remained stable, but MMSE, MoCA and ADL scores were reduced after 6 months of treatment. Memantine was well-tolerated in patients. In conclusion, patients with moderate-to-severe bvFTD responded significantly better to memantine in comparison to patients with mild bvFTD with regard to their neuropsychiatric scores, while memantine did not present any cognitive or functional benefits in patients with mild bvFTD. A randomized, double-blind, placebo-controlled clinical trial with a larger number of patients is required to verify these promising results for patients with moderate-to-severe bvFTD.

Dementia-related agitation: a review of non-pharmacological interventions and analysis of risks and benefits of pharmacotherapy

“…Several standardized tests scores (see Appendix) employed to measure the outcome showed no statistically significant benefit of memantine over placebo in reducing the symptoms of agitation and aggression in moderate-to-severe AD. Quite contrarily, Li et al, 29 claim memantine treatment has beneficial effects on neuropsychiatric symptoms of patients with moderate-to-severe form of behavioral variant frontotemporal dementia (bvFTD) after conducting a six-month, open-label, self-controlled clinical trial on 42 outpatients. The patients were treated with 20 mg memantine daily (as was the case with Herrmann et al 28 ) for six months’ duration.…”

Frontotemporal dementia in psychiatric practice: diagnostic and therapeutic aspects

“…Рандомизированные исследования не были завершены, так как не удалось набрать первоначально запланированное количество пациентов, а их результаты не продемонстрировали значительные улучшение поведенческих симптомов и изменения общего клинического впечатления [4,30]. В открытых исследованиях было показано, что мемантин в дозе 20 мг/сут улучшает поведенческие и психопатологические симптомы, такие как тревога, депрессия, апатия и расторможенность, особенно у пациентов с ПЛВД на стадии умеренной и тяжелой деменции [5,14,28]. Однако, эти результаты должны интерпретироваться с осторожностью из-за относительно небольшого числа больных, участвующих в исследовании.…”

Cognitive and non-cognitive neuropsychiatric disorders in dementia and methods of their correction

“…Это исследование позволяет сде-лать вывод, что специфическая терапия БА легкой и уме-ренной степени тяжести, особенно с использованием ме-мантина и ривастигмина, эффективна в отношении ней-ропсихических симптомов и не сопровождается серьезны-ми побочными реакциями [56]. Получены многообещаю-щие результаты при использовании мемантина у пациентов с умеренной и тяжелой степенью лобно-височной демен-ции в отношении нейропсихических симптомов [57].…”