NEJM Audio Summary - March 8, 2012

Excerpted Script

3'18" | "Donepezil and Memantine for Moderate-to-Severe Alzheimer's Disease" by Robert Howard. From King's College London. The authors investigated whether community-living patients with Alzheimer's disease, who have moderate-to-severe disease and are already receiving donepezil, benefit from continuing treatment and whether initiating memantine at this point in the course of the disease is beneficial. Patients assigned to continue donepezil, as compared with those assigned to discontinue donepezil, had a score on the Standardized Mini-Mental State Examination that was higher by an average of 1.9 points and a score on the Bristol Activities of Daily Living Scale that was lower (indicating less impairment) by 3.0 points. Patients assigned to receive memantine, as compared with those assigned to receive memantine placebo, had a score that was an average of 1.2 points higher and a score that was 1.5 points lower, respectively.  There were no significant benefits of the combination of donepezil and memantine over donepezil alone. In patients with moderate or severe Alzheimer's disease, continued treatment with donepezil was associated with cognitive benefits that exceeded the minimum clinically important difference and with significant functional benefits over the course of 12 months.

4'47" | In editorial Lon Schneider from From University of Southern California Keck School of Medicine, Los Angeles, write that memantine appears to be helpful for the treatment of moderate-to-severe Alzheimer's disease when used alone or when replacing donepezil, however, the results of this trial do not support the typical use in the United States, and an FDA-approved use, as add-on therapy to established donepezil treatment.

和訳は、otoweltさんのブログ「呼吸器内科医」の投稿「Alzheimer病におけるドネペジルの継続は有用」を参照してください。日本神経学会による『認知症疾患治療ガイドライン２０１０』は、ドネペジル、メマンチン、ガランタミン、リバスチグミンの４剤をグレードＡとしておりますが、Archives of Neurologyに「メマンチンは、軽度アルツハイマー病患者の効果において有意差を認めなかった」と報告した論文が発表されています。周辺症状に対して、特にレヴィ小体病による幻覚では、抑肝散の効果が有名です。