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The Behavioral Effects of Combination Therapy of Memantine and Acetylcholinesterase Inhibitors Compared with Acetylcholinesterase Inhibitors Alone in Patients with Moderate Alzheimer’s Dementia: A Double-Blind Randomized Placebo-Controlled Trial

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주제분류정신과학

초록

Objective This study aimed to investigate treatment effects of combination therapy of memantine and acetylcholinesterase inhibitors (AchEIs) compared with AchEIs alone on behavioral and psychological symptoms of dementia (BPSD) in patients with moderate Alzheimer’s dementia (AD).Methods This was a 12-week, double-blind, randomized, placebo-controlled trial. A total of 148 patients with moderate AD participated in this study. Mini-Mental State Examination, Neuropsychiatric Inventory (NPI), Clinician’s Interview-Based Impression of Change plus caregiver input, Gottfries–Bråne–Steen Scale, and Zarit Burden Interview were used as assessment scales.Results There were no significant differences in age, sex, or education between AChEIs alone and combination groups. The combination group showed significantly more improvement of NPI-disinhibition score (0.76±2.15) than the AChEIs alone group (-0.14±1.71) after 12 weeks.Conclusion Our findings suggest that the combination therapy of memantine and AchEIs might be a beneficial option for reducing disinhibition symptoms of patients with moderate AD compared with AchEIs alone. We believe that clinicians need to consider additional memantine treatment when patients with moderate AD complain disinhibition symptom. A larger clinical trial is needed to further determine the efficacy and advantages of such combination therapy of memantine and AchEIs for treating BPSD of patients with moderate AD.

Abstract

Objective This study aimed to investigate treatment effects of combination therapy of memantine and acetylcholinesterase inhibitors (AchEIs) compared with AchEIs alone on behavioral and psychological symptoms of dementia (BPSD) in patients with moderate Alzheimer’s dementia (AD).Methods This was a 12-week, double-blind, randomized, placebo-controlled trial. A total of 148 patients with moderate AD participated in this study. Mini-Mental State Examination, Neuropsychiatric Inventory (NPI), Clinician’s Interview-Based Impression of Change plus caregiver input, Gottfries–Bråne–Steen Scale, and Zarit Burden Interview were used as assessment scales.Results There were no significant differences in age, sex, or education between AChEIs alone and combination groups. The combination group showed significantly more improvement of NPI-disinhibition score (0.76±2.15) than the AChEIs alone group (-0.14±1.71) after 12 weeks.Conclusion Our findings suggest that the combination therapy of memantine and AchEIs might be a beneficial option for reducing disinhibition symptoms of patients with moderate AD compared with AchEIs alone. We believe that clinicians need to consider additional memantine treatment when patients with moderate AD complain disinhibition symptom. A larger clinical trial is needed to further determine the efficacy and advantages of such combination therapy of memantine and AchEIs for treating BPSD of patients with moderate AD.

참고문헌 (43)

  1. Xu J, "Biomarkers for Preclinical Alzheimer’s Disease", pp.3~13 (2018), Springer
  2. Ji Won Han, "Overview of the Korean Longitudinal Study on Cognitive Aging and Dementia", PSYCHIATRY INVESTIGATION, 15(8), pp.767~774 (2018), 대한신경정신의학회[DOI]
  3. Korean Dementia Observatory 2019, "National Institute of Dementia", National Institute of Dementia, ~ (2020)
  4. Beeri MS, "The cost of behavioral and psychological symptoms of dementia(BPSD)in community dwelling Alzheimer’s disease patients", Int J Geriatr Psychiatry, 17, pp.403~408 (2002)
  5. Lowery D, "Behavioural and psychological symptoms of dementia(BPSD) : the personal and practical costs of dementia", J Integr Care, 17, pp.13~19 (2009)
  6. Olazaran-Rodriguez J, "Psychological and behavioural symptoms of dementia : prevention, diagnosis and treatment", Rev Neurol, 55, pp.598~608 (2012)
  7. Teri L, "Behavior and caregiver burden : behavioral problems in patients with Alzheimer disease and its association with caregiver distress", Alzheimer Dis Assoc Disord, 11(Suppl 4), pp.S35~S38 (1997)
  8. 윤현철, "치매의 약물요법", 대한의사협회지, 61(12), pp.758~764 (2018), 대한의사협회[DOI]
  9. Trinh NH, "Efficacy of cholinesterase inhibitors in the treatment of neuropsychiatric symptoms and functional impairment in Alzheimer disease : a meta-analysis", JAMA, 289, pp.210~216 (2003)
  10. Azermai M, "Dealing with behavioral and psychological symptoms of dementia : a general overview", Psychol Res Behav Manag, 8, pp.181~185 (2015)
  11. Wang F, "Drug Therapy for Behavioral and Psychological Symptoms of Dementia", Curr Neuropharmacol, 14, pp.307~313 (2016)
  12. Bains J, "Antidepressants for treating depression in dementia", Cochrane Database Syst Rev, 4, pp.CD003944~ (2002)
  13. Tampi RR, "Efficacy and tolerability of benzodiazepines for the treatment of behavioral and psychological symptoms of dementia : a systematic review of randomized controlled trials", Am J Alzheimers Dis Other Demen, 29, pp.565~574 (2014)
  14. "Encephale", 2008, 409~415
  15. Rogawski MA, "The neuropharmacological basis for the use of memantine in the treatment of Alzheimer’s disease", CNS Drug Rev, 9, pp.275~308 (2003)
  16. McShane R, "Memantine for dementia", Cochrane Database Syst Rev, 2, pp.CD003154~ (2006)
  17. Winblad B, "Memantine in moderate to severe Alzheimer’s disease : a meta-analysis of randomised clinical trials", Dement Geriatr Cogn Disord, 24, pp.20~27 (2007)
  18. Johnson JW, "Mechanism of action of memantine", Curr Opin Pharmacol, 6, pp.61~67 (2006)
  19. Parsons CG, "Memantine and cholinesterase inhibitors : complementary mechanisms in the treatment of Alzheimer’s disease", Neurotox Res, 24, pp.358~369 (2013)
  20. American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders: DSM-5TM" (2013), American Psychiatric Publishing, Inc
  21. Folstein MF, ""Mini-mental state". A practical method for grading the cognitive state of patients for the clinician", J Psychiatr Res, 12, pp.189~198 (1975)
  22. 이동영, "Mini-Mental State Examination의 한국 노인 정상규준 연구", 신경정신의학, 41(3), pp.508~525 (2002), 대한신경정신의학회
  23. Cummings JL, "The Neuropsychiatric Inventory : comprehensive assessment of psychopathology in dementia", Neurology, 44, pp.2308~2314 (1994)
  24. Choi SH, "The Korean version of the neuropsychiatric inventory : a scoring tool for neuropsychiatric disturbance in dementia patients", J Korean Med Sci, 15, pp.609~615 (2000)
  25. Reisberg B, "Clinical global measures of dementia. Position paper from the International Working Group on Harmonization of Dementia Drug Guidelines", Alzheimer Dis Assoc Disord, 11(Suppl 3), pp.8~18 (1997)
  26. Gottfries CG, "A new rating scale for dementia syndromes", Arch Gerontol Geriatr, 1, pp.311~330 (1982)
  27. Zarit SH, "Subjective burden of husbands and wives as caregivers : a longitudinal study", Gerontologist, 26, pp.260~266 (1986)
  28. 배경열, "노인의 인지기능에 따른 부양자의 부양부담", 생물치료정신의학, 12(1), pp.66~75 (2006), 대한생물치료정신의학회
  29. Youn H, "Obstetric risk factors for depression during the postpartum period in South Korea : a nationwide study", J Psychosom Res, 102, pp.15~20 (2017)
  30. Margallo-Lana M, "Prevalence and pharmacological management of behavioural and psychological symptoms amongst dementia sufferers living in care environments", Int J Geriatr Psychiatry, 16, pp.39~44 (2001)
  31. Haibo X, "Prevalence and severity of behavioral and psychological symptoms of dementia(BPSD)in community dwelling Chinese : findings from the Shanghai three districts study", Aging Ment Health, 17, pp.748~752 (2013)
  32. van der Linde RM, "Longitudinal course of behavioural and psychological symptoms of dementia : systematic review", Br J Psychiatry, 209, pp.366~377 (2016)
  33. Tariot PN, "Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil : a randomized controlled trial", JAMA, 291, pp.317~324 (2004)
  34. Grossberg GT, "The safety, tolerability, and efficacy of once-daily memantine(28 mg) : a multinational, randomized, double-blind, placebo-controlled trial in patients with moderate-to-severe Alzheimer’s disease taking cholinesterase inhibitors", CNS Drugs, 27, pp.469~478 (2013)
  35. Porsteinsson AP, "Memantine treatment in patients with mild to moderate Alzheimer’s disease already receiving a cholinesterase inhibitor : a randomized, double-blind, placebo-controlled trial", Curr Alzheimer Res, 5, pp.83~89 (2008)
  36. Choi SH, "Tolerability and efficacy of memantine add-on therapy to rivastigmine transdermal patches in mild to moderate Alzheimer’s disease : a multicenter, randomized, open-label, parallel-group study", Curr Med Res Opin, 27, pp.1375~1383 (2011)
  37. Carotenuto A, "The Effect of the Association between Donepezil and Choline Alphoscerate on Behavioral Disturbances in Alzheimer’s Disease : Interim Results of the ASCOMALVA Trial", J Alzheimers Dis, 56, pp.805~815 (2017)
  38. Starkstein SE, "Prevalence and clinical correlates of disinhibition in dementia", Cogn Behav Neurol, 17, pp.139~147 (2004)
  39. Povysheva NV, "Effects of memantine on the excitation-inhibition balance in prefrontal cortex", Neurobiol Dis, 96, pp.75~83 (2016)
  40. Araki T, "The effects of combine treatment of memantine and donepezil on Alzheimer’s disease patients and its relationship with cerebral blood flow in the prefrontal area", Int J Geriatr Psychiatry, 29, pp.881~889 (2014)
  41. Zamboni G, "Apathy and disinhibition in frontotemporal dementia : Insights into their neural correlates", Neurology, 71, pp.736~742 (2008)
  42. Lyketsos CG, "Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment : results from the cardiovascular health study", JAMA, 288, pp.1475~1483 (2002)
  43. Kaufer DI, "Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory", J Neuropsychiatry Clin Neurosci, 12, pp.233~239 (2000)

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