Memantine induces manic episode in a 73-year-old patient with vascular neurocognitive disorder: a case report

Abstract

Memantine, an N-methyl-d-aspartate receptor antagonist, is a well-established treatment option for moderate-to-severe cognitive impairment related to Alzheimer disease. Recently, growing evidence has indicated memantine might also be effective in treatment of affective disorders. The common drug-induced adverse events of memantine include confusion, dizziness, drowsiness, headache, insomnia, and agitation. Herein, we presented a case of a 73-year-old female patient with vascular neurocognitive disorder, who developed a manic episode after taking memantine.

Life-threatening altered mental status secondary to memantine in an adolescent undergoing cranial radiotherapy for medulloblastoma

“…This is the first report of grade 4 confusion (Common Terminology Criteria for Adverse Events version 5) attributed to memantine in a patient undergoing radiation therapy. 3–6…”

“…A limited number of case reports have highlighted unexpected adverse events with memantine. Reported significant toxicities include catatonia, 4 mania, 5 myoclonus, 7,8 dystonia, 9 and vivid dreams/nightmares. 10 Savić and Mimica 6 described repeated, unexplained loss of consciousness in two patients receiving long-term memantine for Alzheimer's disease.…”

“…This is the first report of grade 4 confusion (Common Terminology Criteria for Adverse Events version 5) attributed to memantine in a patient undergoing radiation therapy. [3][4][5][6] In correlation with memantine's half-life, the patient's symptoms significantly improved 50 h after discontinuing memantine. Memantine is partially metabolized in the liver and predominantly excreted in urine.…”

Bipolar Disorder and Manic-Like Symptoms in Alzheimer’s, Vascular and Frontotemporal Dementia: A Systematic Review

“…Although the number of observed AD patients developing mania with AChEI treatment is small and the pathophysiological mechanism is not clear, the close temporal relationship between onset and improvement of manic episodes with administration and discontinuation of AChEIs suggests the existence of a causal link. Moreover, the effect of AChEIs on mood is not limited to patients with AD, but it has been reported in patients affected by different brain neurological illnesses, from neurocognitive disorders to cerebrovascular diseases [ 32 - 37 ]. It is plausible that previous mood disorders or subclinical mood symptoms associated to neuropathological alterations confer a vulnerability to mood elevation with AChEI use.…”

“…We suppose, in fact, that mania due to a cerebrovascular disease does not necessarily become evident in the short term but may have latency and emerge as a result of further clinical or sub-clinical ischemic events and/or after the occurrence of other predisposing factors such as the aging process. After excluding a case report in which vascular damage has not been ascertained [ 50 ], seven cases met the criteria for full-text review [ 37 , 51 - 55 ], and five more were included by hand-searching from reference lists [ 56 - 60 ]. Patients have been grouped into cortico-subcortical VCI due to large vessel disease, subcortical VCI due to small vessel disease, and VCI due to CADASIL disease (Table 3 ).…”