Gareri Pietro, Putignano Daria, Castagna Alberto, Cotroneo Antonino Maria, De Palo Grazia, Fabbo Andrea, Forgione Luigi, Giacummo Attilio, Lacava Roberto, Marino Saverio, Simone Maurizio, Zurlo Amedeo, Putignano Salvatore
Elderly Health Care, Ambulatory Center for Dementia, ASP Catanzaro, Catanzaro, Italy.
A.G.E, Naples, Italy.
J Alzheimers Dis. 2014;41(2):633-40. doi: 10.3233/JAD-132735.
Combined therapy of memantine and acetylcholinesterase inhibitors (AChEIs) in patients with Alzheimer's disease (AD) may be associated with higher benefits than either monotherapy.
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.
A total number of 240 patients (61.7% of women, 38.3% men, mean age 77.9 ± 7.32 years old) who had started treatment with the combination therapy were recruited. At baseline (T0), Month 3 (T1), and Month 6 (T2), cognitive functions were assessed by Mini-Mental State Examination (MMSE), functional dependence by activities of daily living (ADL) and instrumental ADL, behavioral disturbances by the Neuropsychiatric Inventory (NPI), and comorbidities by Cumulative Illness Rating Scale. Adverse events were reported during the study.
MMSE total score significantly increased at Month 6 (p = 0.029 versus month 3) and IADL total score significantly decreased from baseline to endpoint (p = 0.033). There were no significant changes from baseline in mean ADL, despite significant improvements in NPI total score. The mean MMSE total score significantly increased with the combination donepezil + memantine compared to rivastigmine + memantine. The adverse events profile was in line with the expected range of the drugs studied and concomitant therapies. Overall, 17 patients discontinued treatment in the observation time.
Combined treatment with memantine and AChEIs was effective in patients with AD, particularly in slowing cognitive impairment and preventing the onset of agitation and aggression in elderly AD patients.
在阿尔茨海默病（AD）患者中，美金刚与乙酰胆碱酯酶抑制剂（AChEIs）联合治疗可能比单一疗法具有更高的疗效。
这项在意大利七个门诊痴呆中心进行的回顾性多中心研究，评估了在认知功能和行为障碍恶化的AD患者中，除AChEI外，每天服用20 mg美金刚6个月的疗效和安全性。
共招募了240例开始联合治疗的患者（女性占61.7%，男性占38.3%，平均年龄77.9±7.32岁）。在基线（T0）、第3个月（T1）和第6个月（T2），通过简易精神状态检查表（MMSE）评估认知功能，通过日常生活活动（ADL）和工具性ADL评估功能依赖程度，通过神经精神科问卷（NPI）评估行为障碍，通过累积疾病评定量表评估合并症。研究期间报告不良事件。
第6个月时MMSE总分显著增加（与第3个月相比，p = 0.029），IADL总分从基线到终点显著降低（p = 0.033）。尽管NPI总分有显著改善，但平均ADL与基线相比无显著变化。与利伐斯的明+美金刚相比，多奈哌齐+美金刚联合使用时MMSE总分显著增加。不良事件情况与所研究药物和伴随治疗的预期范围一致。总体而言，17例患者在观察期内停止治疗。
美金刚与AChEIs联合治疗对AD患者有效，尤其在减缓认知障碍以及预防老年AD患者出现激越和攻击行为方面。
