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memantine donepezil agitation

Torsten Kratz
BACKGROUND: Behavioral disorders such as aggressiveness, agitation, delusions, disinhibition, affect lability, and apathy arise in more than 90% of patients with dementia. Behavioral disorders are a major challenge and the greatest stress factor in everyday life for nursing personnel and for family members caring for the patient. METHODS: This review is based on relevant publications retrieved by a selective literature search in the PubMed, Cochrane Library, and German S3 guideline databases with the search terms "behavioral disorders," "non-cognitive disorders," and "challenging behavior," in conjunction with "dementia" and "behavioral and psychological symptoms of dementia...
June 30, 2017: Deutsches Ärzteblatt International
John T O'Brien, Clive Holmes, Matthew Jones, Roy Jones, Gill Livingston, Ian McKeith, Peter Mittler, Peter Passmore, Craig Ritchie, Louise Robinson, Elizabeth L Sampson, John-Paul Taylor, Alan Thomas, Alistair Burns
The British Association for Psychopharmacology coordinated a meeting of experts to review and revise its previous 2011 guidelines for clinical practice with anti-dementia drugs. As before, levels of evidence were rated using accepted standards which were then translated into grades of recommendation A-D, with A having the strongest evidence base (from randomised controlled trials) and D the weakest (case studies or expert opinion). Current clinical diagnostic criteria for dementia have sufficient accuracy to be applied in clinical practice (B) and both structural (computed tomography and magnetic resonance imaging) and functional (positron emission tomography and single photon emission computerised tomography) brain imaging can improve diagnostic accuracy in particular situations (B)...
February 2017: Journal of Psychopharmacology
Nan Zhang, Changjuan Wei, Hongjian Du, Fu-Dong Shi, Yan Cheng
BACKGROUND/AIMS: Memantine has been approved by the Food and Drug Administration for the treatment of moderate-to-severe Alzheimer's disease (AD). However, the effect of memantine on patients with mild-to-moderate AD is unclear. METHODS: This study is a post hoc analysis of a double-blind clinical trial. Donepezil was used as the standard control treatment. Outcomes included score changes from baseline to week 24 on the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog), a modified 20-item Activities of Daily Living Scale (ADL), the Neuropsychiatric Inventory (NPI), and the Mini-Mental State Examination (MMSE) as well as the score of the Clinician's Interview-Based Impression of Change plus Caregiver Input (CIBIC-Plus)...
2015: Dementia and Geriatric Cognitive Disorders
Stephen L Thornton, Richard F Clark
Donepezil and memantine are commonly prescribed antidementia drugs. There is a paucity of literature concerning pediatric ingestions of these drugs. We describe a case of a 2-year-old child who developed encephalopathy after an unintentional ingestion of donepezil and memantine. A 2-year-old girl was found by her family members agitated and reporting visual hallucinations. In the emergency department, she became sedated and had rightward eye deviation. She was hospitalized and had extensive neurological and infectious disease testing that was unremarkable, except for an electroencephalogram, which showed a nonspecific encephalopathy...
September 2014: Pediatric Emergency Care
Pietro Gareri, Daria Putignano, Alberto Castagna, Antonino Maria Cotroneo, Grazia De Palo, Andrea Fabbo, Luigi Forgione, Attilio Giacummo, Roberto Lacava, Saverio Marino, Maurizio Simone, Amedeo Zurlo, Salvatore Putignano
BACKGROUND: Combined therapy of memantine and acetylcholinesterase inhibitors (AChEIs) in patients with Alzheimer's disease (AD) may be associated with higher benefits than either monotherapy. OBJECTIVE: This retrospective multicentric study conducted in seven Italian Ambulatory Centers for Dementia assessed the efficacy and safety of memantine 20 mg/day administered for 6 months in addition to an AChEI in AD patients with worsened cognitive functions and behavioral disorders...
2014: Journal of Alzheimer's Disease: JAD
Eduardo Cumbo, Leonarda Domenica Ligori
BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) occur in up to 80% of Alzheimer's disease (AD) patients and represent one of the most common reasons for early institutionalization and increase in management costs. OBJECTIVES: This study evaluated the effects of four drugs (memantine, donepezil, rivastigmine, galantamine) in BPSD in AD patients. METHODS: This was a prospective, longitudinal, randomized, open-label, 4-arm, parallel-group, 12-month clinical trial carried out in 177 AD patients...
2014: Journal of Alzheimer's Disease: JAD
Osamu Kano, Hirono Ito, Takanori Takazawa, Yuji Kawase, Kiyoko Murata, Konosuke Iwamoto, Tetsuro Nagaoka, Takehisa Hirayama, Ken Miura, Riya Nagata, Tetsuhito Kiyozuka, Jo Aoyagi, Ryuta Sato, Teruo Eguchi, Ken Ikeda, Yasuo Iwasaki
Clinical trials have shown the benefits of acetylcholinesterase inhibitors, such as donepezil and galantamine, and an N-methyl-D-aspartate receptor antagonist, memantine, in patients with Alzheimer's disease (AD). However, little is known regarding the effects of switching from donepezil 5 mg/day to galantamine 16 or 24 mg/day, or regarding the effects of adding memantine to established therapy compared with increasing the dose of donepezil. This report discusses two studies conducted to evaluate treatment with galantamine and memantine with respect to cognitive benefits and caregiver evaluations in patients with AD receiving donepezil 5 mg/day for more than 6 months...
2013: Neuropsychiatric Disease and Treatment
J Jacquy
Current evidence tends to support the notion that Alzheimer's disease may be postponed by implementing interventions toward the potential etiologic factors (both risk and protective factors) (i.e., primary prevention) and by early detection (i.e., secondary prevention). Epidemiologic research has provided sufficient evidence that vascular risk factors in middle-aged and older adults play a significant role in the development and progression of dementia and AD, whereas extensive social network and active engagement in mental, social, and physical activities may postpone the onset of the dementing disorder...
September 2010: Revue Médicale de Bruxelles
John T O'Brien, Alistair Burns
The British Association for Psychopharmacology (BAP) coordinated a meeting of experts to review and revise its first (2006) Guidelines for clinical practice with anti-dementia drugs. As before, levels of evidence were rated using accepted standards which were then translated into grades of recommendation A to D, with A having the strongest evidence base (from randomized controlled trials) and D the weakest (case studies or expert opinion). Current clinical diagnostic criteria for dementia have sufficient accuracy to be applied in clinical practice (B) and brain imaging can improve diagnostic accuracy (B)...
August 2011: Journal of Psychopharmacology
Oana Creţu, Andreea Silvana Szalontay, Roxana Chiriţă, V Chiriţă
OBJECTIVE: Investigating the behavioral and cognitive effect of memantine in moderate to severe patients with Alzheimer's disease receiving donepezil. MATERIAL AND METHOD: 43 patients were enrolled in this prospective, randomized, parallel group study. There were no significant imbalances between the treatment groups in demographic and baseline clinical characteristics. Cognitive and global measures were collected at baseline and at the end of weeks 4, 8, 12 and 24...
July 2008: Revista Medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti Din Iaş̧i
Robert J van Marum
Memantine is a low to moderate affinity N-methyl-D-aspartate receptor (NMDAR) antagonist. The effects of memantine in Alzheimer's disease (AD) have been studied in 7 randomized controlled trials in many post-hoc analyses. Three out of four RCTs in patients with moderate to severe AD (Mini Mental State Examination [MMSE] <14) showed a statistically significant but clinically small positive effect of memantine on cognition, global functioning, activities of daily living (ADL) and neuropsychiatric symptoms...
2009: Neuropsychiatric Disease and Treatment
Dan Moellentin, Claudia Picone, Emma Leadbetter
OBJECTIVE: To report a case of myoclonus and delirium seen in a patient taking a combination of memantine and trimethoprim. CASE SUMMARY: A 78-year-old woman was admitted to the medical center in October 2007 with rapid deterioration of Alzheimer's dementia and progressive myoclonus. In 2003, donepezil 5 mg/day had been initiated and her disease slowly progressed. In 2006, memantine 10 mg twice daily was added. Myoclonic activity and delirium were noted in 2007 when a urinary tract infection (UTI) was treated with double-strength trimethoprim/sulfamethoxazole (TMP/SMX 160 mg/800 mg)...
March 2008: Annals of Pharmacotherapy
Lisa J Miller
OBJECTIVE: To review the literature for double-blind, placebo-controlled trials that examined the efficacy of cognitive enhancers in the psychopathology of Alzheimer's disease. DATA SOURCES: Literature searches were conducted using MEDLINE and EMBASE databases and STUDY SELECTION: Overall, 55 articles were reviewed for inclusion. Several open-label studies and case reports were found on this topic, but only those involving both tacrine and use of the Neuropsychiatric Inventory were included...
September 2007: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
Dennis Seow, Serge Gauthier
OBJECTIVE: To systematically review published clinical trials of the pharmacotherapy of Alzheimer disease (AD). METHOD: We searched MEDLINE for published English-language medical literature, using Alzheimer disease and treatment as key words. No other search engine was used. Our review focused on randomized clinical trials (RCTs) and corresponding metaanalyses. RESULTS: Although there are many RCTs for the treatment of mild cognitive impairment (MCI), none have been successful in their primary analysis...
October 2007: Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie
Lori A Daiello
Atypical antipsychotics will continue to be prescribed for the behavioral symptoms of dementia in the absence of more effective, better tolerated, and safer alternatives. The evidence base, although incomplete, suggests that modest treatment effect sizes are offset by risk of considerable adverse effects. How might this information be best applied to clinical practice? Non-pharmacologic strategies should be implemented in routine clinical practice. Placebo-controlled clinical trials of individual antipsychotic agents have historically reported high placebo response rates; CATIE-AD reported that the sum total of the risk/benefit equation of atypical antipsychotic therapy was no greater than that achieved by placebo...
June 2007: Medicine and Health, Rhode Island
George S Alexopoulos, Dilip V Jeste, Henry Chung, Daniel Carpenter, Ruth Ross, John P Docherty
OBJECTIVES: New treatment options for dementia and its behavioral disturbances have become available since publication of The Expert Consensus Guidelines on the Treatment of Agitation in Older Persons with Dementia in 1998. While only 2 cholinesterase inhibitors, donepezil and tacrine, were available in 1998, 3 new cognitive-enhancing agents have been introduced since that time as well as several new atypical antipsychotics and antidepressants. However, there are still limited data from controlled studies to guide clinicians in choosing among these agents and sequencing and combining treatments...
January 2005: Postgraduate Medicine
Jeffrey L Cummings, Eugene Schneider, Pierre N Tariot, Stephen M Graham
OBJECTIVE: To investigate the behavioral effects of memantine in moderate to severe Alzheimer disease (AD). METHODS: The authors conducted a hypothesis-generating, exploratory analysis of a 24-week, double-blind, placebo-controlled trial comparing memantine (20 mg/day) with placebo in subjects with moderate to severe AD on stable donepezil treatment. They employed the Neuropsychiatric Inventory (NPI; 12-item), administered at baseline, week 12, and week 24, to assess the effects of memantine on behavior...
July 11, 2006: Neurology
S Gauthier, Y Wirth, H J Möbius
INTRODUCTION: Behavioural symptoms are common in moderate to severe Alzheimer's disease (AD). We have analysed the databases of two randomised studies with regard to the effects of memantine treatment on behavioural symptoms, measured using the 12-item version of the Neuropsychiatric Inventory (NPI). SUBJECTS: The monotherapy study (memantine only) reported by Reisberg et al. (2003) involved 252 patients with baseline MMSE total score of between 3 and 14, whereas the combination study (memantine and donepezil) reported by Tariot et al...
May 2005: International Journal of Geriatric Psychiatry
Danièle Bentué-Ferrer, Olivier Tribut, Elisabeth Polard, Hervé Allain
Cholinesterase inhibitors are the only pharmacological class indicated for the treatment of mild to moderate Alzheimer's disease. These drugs are also being used off label to treat severe cases of Alzheimer's disease or vascular dementia and other disorders. The widespread use of cholinesterase inhibitors raises the possibility of their use in combination regimens, with the subsequent risk of deleterious drug-drug interactions in high-risk populations. The purpose of this review is to present the possible sources of pharmacokinetic or pharmacodynamic drug-drug interactions involving cholinesterase inhibitors...
2003: CNS Drugs
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