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Namenda Treatment of Psychosis and Behavioral Disturbance in Dementia

Could Namenda (memantine) be a significant step away from using neuroleptic/antipsychotic medication for the treatment of behavioral disturbance and psychosis in dementia? With the increasing negative attention antipsychotic medication has been receiving in the national media for its severe potential side effects ranging from sedation and falls to strokes and increased mortality, this would be welcome news indeed.

Gordon K. Whitlock et al. in the March edition of The Journal of Clinical Psychiatry suggest that Namenda may be more effective treatment than antipsychotics for behavioral disturbance and psychosis in Alzheimer’s disease.

Behavioral disturbance and psychosis in dementia is common. 90% of patients with dementia develop one or more symptoms categorized as agitation/aggression and psychosis. Agitation/aggression is a broad and non-specific category of behaviors. A more precise way of characterizing behavioral disturbance is through scales such as the Cohen-Mansfield Agitation Inventory.

The authors of this study found that memantine was statistically superior to placebo in patients with agitation/aggression using the Neuropsychiatric Inventory (NPI) which lists “agitation/aggression” as one measure. The positive treatment effect was sustained during the 24 week study period. There was also improvement in patients with delusions and hallucinations but this was not statistically significant because of the small sample size.

Namenda was effective in preventing the emergence of behavioral disturbances. Only 20.3% of the asymptomatic memantine treated patients developed behavioral disturbances compared to 31.9% in the placebo group at end of the six-month study.

The degree of treatment benefit due to Namenda was similar to that of antipsychotics too. At 12 weeks the response rate was 13% higher than placebo. This compares favorably to studies with antipsychotics where a response rate of 5% to 11% has been observed.

In contrast to antipsychotics, Namenda was well tolerated. The adverse effect profile was similar to placebo with the absence of events sometimes seen in antipsychotic treatment such as peripheral edema, upper respiratory tract infection, and cerebrovascular disorder.

This study also suggests that Namenda may play a role in slowing the decline of dementia. It has been observed that patients with behavioral disturbance and psychosis have a more rapid disease progression with increased risk of injury to themselves or others. Namenda was effective at slowing the rate of this progression by lowering the propensity for developing behavioral symptoms and preventing them in asymptomatic patients.

While the authors state that further study is necessary to assess benefit to patients with psychosis, these results are promising. The use of Namenda could prevent the future necessity for the less well tolerated antipsychotic class of medication now used to treat behavioral disturbances and psychosis in dementia.

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