A new Alzheimer’s drug, already approved in Europe, offers potential benefits to caregivers as well as the people they care for, according to a study in the April 3, 2003, New England Journal of Medicine (NEJM). In a clinical trial, caregivers spent an average of 46 fewer hours per month with Alzheimer’s patients taking the medication, called memantine. It is available in Europe and is expected to gain approval in the United States by the end of 2003.
Four drugs, all members of a class called cholinesterase inhibitors, are currently approved in the United States for treatment of Alzheimer’s disease: donepezil (Aricept), galantamine (Reminyl), rivastigmine (Excelon), and tacrine (Cognex). These are specifically approved to relieve mild-to-moderate symptoms and may slow the progression of the disease. Memantine was evaluated in the NEJM study for treatment of moderate-to-severe Alzheimer’s.
The study involved 252 people with moderate-to-severe Alzheimer’s who were chosen at random to receive either memantine or an inactive placebo (“sugar pill”). At the start of the trial and then after seven months of treatment, the participants took standard tests of thinking ability, memory, and ability to function independently.
The study found that the people taking memantine did not worsen during the trial period, and may have improved slightly on several tests. One improvement occurred in the test of people’s ability to perform “activities of daily living,” such as personal hygiene, cooking, and going to the bathroom. Over the 28-week course of the trial, people on memantine declined significantly less than people taking the placebo.
These findings suggest that memantine may allow people with advanced Alzheimer’s to function slightly more independently, thus relieving some of the daily pressure on caregivers—often family members with pressures and responsibilities of their own. Because the improvements seen in the tests were slight, further testing will be needed before the clear benefit of this drug to patients and caregivers becomes clear. Also, as yet there have been no studies comparing memantine to existing medications for symptoms of Alzheimer’s disease.
Further Reading: "Memantine in moderate-to-severe Alzheimer's Disease," by B. Reisberg and others. New England Journal of Medicine, vol. 348, pages 1333-1341, 2003.