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Addition of memantine to cholinesterase inhibitor therapy significantly delays time to nursing home admission, observational data suggest

Wednesday, June 10 2009 | Comments

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What's This? Combination therapy with memantine hydrochloride and a cholinesterase inhibitor significantly delays time to nursing home admission relative to cholinesterase inhibitor use alone, according to an analysis conducted at the University of Pittsburgh.

Researchers reviewed data for 943 individuals with probable Alzheimer's disease, all of whom received at least a 1-year follow-up evaluation through their participation in the Alzheimer's Research Program or the Alzheimer Disease Research Center (mean follow-up, 62.3 months; range, 0.8-18 years).

Of these individuals, 140 (14.9%) received treatment with memantine and cholinesterase inhibitors, 387 (45.0%) received only cholinesterase inhibitors, and 416 (40.1%) received neither therapy.

In an analysis adjusted for multiple factors, including age, education, sex, dementia severity, hypertension, diabetes, heart disease, psychiatric symptoms, and psychotropic drug use, the risk of nursing home admission was reduced by a factor of 3.4 among the patients who received cholinesterase inhibitors plus memantine relative to the patients who received cholinesterase inhibitors alone (hazard ratio [HR], 0.29; 95% CI, 0.11-0.72).

At the same time, the patients who received only cholinesterase inhibitors were significantly less likely to enter a nursing home during follow-up than were the patients who received neither therapy (HR, 0.37; 95% CI, 0.27-0.49).

To account for differences related to the year of study entry, researchers conducted a similar analysis restricted to 429 patients who enrolled on or after July 29, 1997--the entry date of the first memantine-treated subject. In this analysis, the patients who received treatment with both memantine and cholinesterase inhibitors were more than 7 times less likely to be admitted to a nursing home during follow-up than were the patients who received only cholinesterase inhibitors (HR, 0.13; 95% CI, 0.03-0.56).
 
Although both cholinesterase inhibitors and combination therapy significantly delayed time to nursing home admission, neither treatment strategy had a significant effect on time to death.

These findings extend the results of short-term trials, which have suggested that combination therapy offers additional cognitive and functional benefit and helps minimize specific symptoms, such as psychiatric symptoms, that increase the risk of nursing home admission, according to the study authors.

"All of this suggests that the patients using combination therapy were more easily cared for by their caregivers, and consequently remained at home for a longer period of time," they commented. (Lopez OL, et al. J Neurol Neurosurg Psychiatry 2009;80:600-607.)

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