Division of Geriatrics and Gerontology, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Mason F Lord Building, Center Tower, Suite 2200, 21224, Baltimore, MD, USA.
BMC Geriatr. 2024 Feb 1;24(1):123. doi: 10.1186/s12877-024-04658-2.
Since 2003 when memantine was first approved for use in the management of moderate-severe Alzheimer's dementia, its use has become more widespread and is being explored in other diseases like neuropathic pain, epilepsy, and mood disorders. Our case uniquely highlights two important adverse effects in a patient who overdosed on memantine. One is hypertension, which is easy to overlook as a medication side effect. The other is echolalia which is the repetition of words and phrases spoken by another person. It is commonly seen in children with autism spectrum disorder and has been reported in older adults with head injuries, delirium, and neurocognitive disorders. The aim of this patient story is to highlight the importance of medication reconciliation with caregivers and knowledge of adverse drug reactions in patient management. This case report has been presented previously in the form of an abstract at the American Geriatrics Society Presidential poster session in May 2023.
Our patient is an 86-year-old man with mild dementia and hypertension, who was brought to the emergency department (ED) due to abrupt onset of altered mental status and auditory hallucinations. Investigations including blood work, CT head and an electroencephalogram (EEG) did not reveal an etiology for this change in his condition. Due to elevated blood pressure on presentation, a nicardipine drip was started, and he was given IV midazolam to assist with obtaining imaging. While reviewing medications with his daughter, it was noted that sixty memantine pills were missing from the bottle. Poison control was contacted and they confirmed association of these features with memantine. With supportive care, his symptoms resolved in less than 100 h, consistent with the half-life of memantine. Notably, our patient was started on Memantine one month prior to this presentation.
Hypertensive urgency and echolalia were the most striking symptoms of our patient's presentation. Though hypertension is a known sign of memantine overdose, it can easily be contributed to medication non-compliance in patients with dementia, being treated for hypertension. According to our literature review, this the first case of memantine overdose presenting with echolalia, a sign that is not commonly associated with adverse reactions to medications. This highlights the importance of an early medication review, especially with caregivers of people with dementia.
自 2003 年美金刚胺首次获准用于治疗中重度阿尔茨海默病以来，其应用已更为广泛，并在其他疾病中得到探索，如神经病理性疼痛、癫痫和情绪障碍。我们的病例独特之处在于，一名过量服用美金刚胺的患者出现了两种重要的不良反应。一种是高血压，这很容易被忽视为药物的副作用。另一种是言语重复，即重复另一个人所说的话和短语。这种情况常见于自闭症谱系障碍儿童，也有报道见于头部受伤、谵妄和神经认知障碍的老年患者。本病例报告的目的是强调与护理人员进行药物调整以及了解药物不良反应在患者管理中的重要性。本病例报告之前曾以摘要形式在美国老年学会总统海报会议上展示。
我们的患者是一名 86 岁男性，患有轻度痴呆症和高血压，因意识状态突然改变和幻听而被送往急诊部。包括血液检查、头部 CT 和脑电图 (EEG) 在内的检查并未发现其病情变化的病因。由于入院时血压升高，开始使用尼卡地平滴注，并给予 IV 咪达唑仑以协助进行影像学检查。在与他的女儿一起审查药物时，注意到瓶子里少了 60 片美金刚胺。联系了中毒控制中心，他们确认了这些特征与美金刚胺有关。经过支持性治疗，他的症状在不到 100 小时内得到缓解，与美金刚胺的半衰期一致。值得注意的是，我们的患者在此次就诊前一个月开始服用美金刚胺。
高血压急症和言语重复是我们患者就诊时最显著的症状。虽然高血压是美金刚胺过量的已知迹象，但在治疗高血压的痴呆症患者中，它很容易被归因于药物不依从。根据我们的文献综述，这是首例美金刚胺过量导致言语重复的病例，这种症状与药物不良反应并不常见。这强调了早期药物审查的重要性，特别是对于痴呆症患者的护理人员。
