combination of galantamine and memantine modifies cognitive function in subjects with amnestic MCI

• Published in: The Journal of nutrition, health & aging Vol. 16; no. 6; pp. 544 - 548
• Main Authors: Peters, Oliver, Lorenz, D, Fesche, A, Schmidtke, K, Hüll, M, Perneczky, R, Rüther, E, Möller, H. -J, Jessen, F, Maier, W, Kornhuber, J, Jahn, H, Luckhaus, C, Gertz, H. -J, Schröder, J, Pantel, J, Teipel, S, Wellek, S, Frölich, L, Heuser, I
• Format: Journal Article
• Language: English
• Published: Paris Springer-Verlag 2012; Springer; Springer Nature B.V
• Subjects: Activities of daily living; Aged; Aging; Alzheimer Disease - physiopathology; Alzheimer's disease; Amnesia - etiology; Amnesia - prevention & control; Biological and medical sciences; Cholinesterase Inhibitors - adverse effects; Cholinesterase Inhibitors - therapeutic use; cognition; Cognition - drug effects; Cognitive ability; Cognitive Dysfunction - drug therapy; Cognitive Dysfunction - etiology; Cognitive Dysfunction - physiopathology; Cohort Studies; Dementia; Dementia - prevention & control; Disease; Disease Progression; Double-Blind Method; drug therapy; Drug Therapy, Combination - adverse effects; drugs; Early Termination of Clinical Trials; Etiology; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Galantamine - adverse effects; Galantamine - therapeutic use; Geriatrics; Geriatrics/Gerontology; Germany; Humans; Male; Medical sciences; Medicine; Medicine & Public Health; Memantine - adverse effects; Memantine - therapeutic use; Memory; Middle Aged; Neuropsychology; Neurosciences; Nootropic Agents - adverse effects; Nootropic Agents - therapeutic use; Nutrition; patients; Primary Care Medicine; Psychiatric Status Rating Scales; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Quality of Life Research; Receptors, N-Methyl-D-Aspartate - antagonists & inhibitors; recruitment; statistical analysis; Tomography; Vertebrates: anatomy and physiology, studies on body, several organs or systems; cognitive function; antidementiva; dementia; Mild cognitive impairment; Cognitive disorder; Galantamine; Benzazepine derivatives; Esterases; Glutamate receptor; Cognition; Acetylcholinesterase; Amantadine derivatives; Alkaloid; ds: Mild cognitive impairment; Degenerative disease; Antagonist; Anticholinesterase agent; Human; Enzyme; Enzyme inhibitor; Metabolic diseases; Antialzheimer agent; Antiparkinson agent; Carboxylic ester hydrolases; Parasympathomimetic; Memantine; Hydrolases; mild cognitive impairment; NMDA receptor; Dementia
• ISSN: 1279-7707; 1760-4788
• DOI: 10.1007/s12603-012-0062-8

OBJECTIVES: Mild cognitive impairment (MCI) is etiologically heterogeneous, and a substantial proportion of MCI subjects will develop different dementia disorders. One subtype of this syndrome, amnestic MCI, occurs preferentially but not exclusively in prodromal AD and is characterized by defined deficits of episodic memory. DESIGN, SETTING AND PARTICIPANTS: For a 2-year, double-blinded, placebo-controlled study MCI patients, presenting with an amnestic syndrome but not necessarily based on presumed prodromal AD were randomized. INTERVENTION: Patients received (a) a combination of 16 mg galantamine plus 20 mg memantine, or (b) 16 mg galantamine alone or (c) placebo. MEASUREMENTS: The primary objective was to explore the differential impact of these interventions on the progression to dementia and on cognitive changes as measured by the ADAScog. RESULTS: After recruitment of 232 subjects, the trial was halted before reaching the planned sample size, because safety concerns arose in other studies with galantamine in MCI. This resulted in a variable treatment duration of 2–52 weeks. The statistical analysis plan was amended for studying cognitive effects of discontinuing the study medication, which was done separately for galantamine and memantine, and under double-blind conditions. There was one death, no unexpected severe adverse events, and no differences of severe adverse events between the treatment arms. The cognitive changes on the ADAScog were not different among the groups. Only for the subgroup of amnestic MCI with presumed AD etiology, a significant improvement of ADAScog score over placebo before the discontinuation of medication was observed, while amnestic MCI presumably due to other etiologies showed no cognitive changes with broad variation. Cognitive improvement was numerically larger in the combination treatment group than under galantamine alone. Patients who received placebo declined as expected. Discontinuation of galantamine, either as part of the combination regimen or as mono treatment, resulted in a transient decline of the ADAScog score in amnestic MCI of presumed AD etiology, while discontinuation of Memantine did not change the cognitive status. CONCLUSION: In an interrupted trial with amnestic MCI subjects the combination of galantamine plus memantine were generally well tolerated. In the subgroup of MCI subjects with presumed AD etiology, a cognitive benefit of a short-term combination treatment of galantamine plus memantine was observed, and cognitive decline occurred after discontinuation of galantamine.