Lerner Alan J, McClendon McKee J, Sami Susie A, Ogrocki Paula K, Adams Kathryn Betts, Smyth Kathleen A
Department of Neurology, University Hospitals Case Medical Center, Cleveland, OH, USA.
Alzheimer Dis Assoc Disord. 2008 Apr-Jun;22(2):137-43. doi: 10.1097/WAD.0b013e31815ccd68.
Memantine is approved by the US Food and Drug Administration for the treatment of moderate to severe Alzheimer disease (AD). We investigated the frequency and variables associated with its use in mild to moderate/severe AD as defined by criteria involving the Mini-Mental Status Examination (MMSE) and Clinical Dementia Rating (CDR) scale. Consecutive possible and probable AD patients seen at our research center from November 2003 to December 2006 were included. Individuals were classified as mild dementia either by CDR=1 or MMSE >or=15, using criteria derived in part from the pivotal trials of memantine used for its approval by the Food and Drug Administration. Of 117 patients, 37% of those with mild AD by MMSE criterion (total N=94), and 38% of those with mild AD by CDR criterion (total N=86) used memantine. Logistic regression was used to simultaneously estimate the odds ratios (ORs) of the likelihood of memantine usage associated with a set of predictor variables. Lower MMSE was associated with a greater likelihood of using memantine independent of CDR [ORMMSE=7.45, 95% confidence interval (CI)=1.50-37.05]; CDR was not significantly related to memantine use. Controlling both MMSE and CDR, Whites were more likely to use memantine than African Americans (OR=6.47, 95% CI=1.25-33.39). Patients who used other antidementia medications were more likely to use memantine than those who did not (OR=3.15, 95% CI=0.995-9.97). Eight other patient characteristics were not significant predictors. Use of memantine in mild AD was common. Patterns of memantine usage are complex and deserve further study in a larger sample because of their implications for medical system cost, equitable access to care, and risk of drug interactions.
美金刚已获美国食品药品监督管理局批准用于治疗中度至重度阿尔茨海默病（AD）。我们依据简易精神状态检查表（MMSE）和临床痴呆评定量表（CDR）所定义的标准，对其在轻度至中度/重度AD中的使用频率及相关变量进行了研究。纳入了2003年11月至2006年12月在我们研究中心就诊的连续的可能及很可能患有AD的患者。依据部分源自美金刚获批时关键试验的标准，若CDR = 1或MMSE≥15，则个体被归类为轻度痴呆。在117例患者中，依据MMSE标准诊断为轻度AD的患者中有37%（总数N = 94）使用了美金刚，依据CDR标准诊断为轻度AD的患者中有38%（总数N = 86）使用了美金刚。采用逻辑回归同时估计与一组预测变量相关的美金刚使用可能性的比值比（OR）。较低的MMSE与使用美金刚的可能性增加相关，且独立于CDR[ORMMSE = 7.45，95%置信区间（CI）= 1.50 - 37.05]；CDR与美金刚的使用无显著相关性。在同时控制MMSE和CDR的情况下，白人比非裔美国人更有可能使用美金刚（OR = 6.47，95% CI = 1.25 - 33.39）。使用其他抗痴呆药物的患者比未使用的患者更有可能使用美金刚（OR = 3.15，95% CI = 0.995 - 9.97）。其他八个患者特征并非显著的预测因素。美金刚在轻度AD中的使用很常见。美金刚的使用模式复杂，鉴于其对医疗系统成本、公平获得医疗服务以及药物相互作用风险的影响，值得在更大样本中进一步研究。
