OBJECTIVE: To estimate the effect of memantine discontinuation for a nonmedical reason (eg, formulary restriction or family decision) on the health status of nursing home (NH) residents with Alzheimer's disease (AD). DESIGN: Retrospective chart review. SETTING: NHs (n = 113) in the United States. PARTICIPANTS: Residents (minimum stay of 90 days) with AD, continuously treated with memantine (MC: n = 273) or discontinued for 60 days or longer (MD: n = 248). The subset of patients who discontinued for a nonmedical reason (MD-N: n = 163) was also analyzed, as was the subset of patients in groups MC and MD-N whose doses of concomitant medications remained stable (MC(s): n = 185; MD-N(s): n = 70). MEASUREMENTS: Thirty-one common geriatric and AD symptoms from NH charts were scored based on their emergence or resolution (+1 or -1 points, respectively), worsening or improvement (+0.5 or -0.5 points, respectively), or absence of change (0 points), compared with the baseline period (the first 30 days analyzed in the charts, during which all residents received memantine treatment). Patients' weight change was also captured. RESULTS: Compared with continuous treatment, memantine discontinuation was associated with a significant increase in the Total AD Symptom Change Score (ie, worsening) in all comparison pairs (MC versus MD, MC versus MD-N, and MC(s) versus MD-N(s): P < .001 for all). The symptoms showing greatest worsening aggregated into two factors: cognition and mood. CONCLUSION:Memantine discontinuation in NH residents with AD may be associated with declining health status, and should be considered with care. A randomized, placebo-controlled trial of treatment discontinuation is merited.
RCT Entities:
OBJECTIVE: To estimate the effect of memantine discontinuation for a nonmedical reason (eg, formulary restriction or family decision) on the health status of nursing home (NH) residents with Alzheimer's disease (AD). DESIGN: Retrospective chart review. SETTING: NHs (n = 113) in the United States. PARTICIPANTS: Residents (minimum stay of 90 days) with AD, continuously treated with memantine (MC: n = 273) or discontinued for 60 days or longer (MD: n = 248). The subset of patients who discontinued for a nonmedical reason (MD-N: n = 163) was also analyzed, as was the subset of patients in groups MC and MD-N whose doses of concomitant medications remained stable (MC(s): n = 185; MD-N(s): n = 70). MEASUREMENTS: Thirty-one common geriatric and AD symptoms from NH charts were scored based on their emergence or resolution (+1 or -1 points, respectively), worsening or improvement (+0.5 or -0.5 points, respectively), or absence of change (0 points), compared with the baseline period (the first 30 days analyzed in the charts, during which all residents received memantine treatment). Patients' weight change was also captured. RESULTS: Compared with continuous treatment, memantine discontinuation was associated with a significant increase in the Total AD Symptom Change Score (ie, worsening) in all comparison pairs (MC versus MD, MC versus MD-N, and MC(s) versus MD-N(s): P < .001 for all). The symptoms showing greatest worsening aggregated into two factors: cognition and mood. CONCLUSION:Memantine discontinuation in NH residents with AD may be associated with declining health status, and should be considered with care. A randomized, placebo-controlled trial of treatment discontinuation is merited.
Authors: Anna D Burke; Roy Yaari; Adam S Fleisher; Helle Brand; Jan Dougherty; James D Seward; Pierre N Tariot Journal: Prim Care Companion CNS Disord Date: 2011