Memantin - et medikament mot demens : Virker det? Er det verdt prisen?

Abstract

Background Memantine is currently the only treatment approved for moderately severe to severe Alzheimer’s disease (AD) in Europe and the United States. Objectives To answer the two questions: “Does memantin work (safely) for people with Alzheimer’s disease, vascular and mixed dementia, and should doctors prescribe it.” Method In answering the first part of the question, the Cochrane review on memantine has been a valuable source. I have benefited from their thorough search for relevant articles. From the selected articles on the effect of memantin, a metaanalysis is presented. To answer the second question, if memantine should be used clinically, pubmed has been an important source in trying to find articles about the relative effect of memantine compared to other drugs and its effect on costs. Selection criteria Double-blind, parallel group, placebo-controlled and randomized trials in which memantine was administered to people with dementia. Main results The evidence suggests that memantine has a positive effect on cognition, behavior and the ability to perform activities of daily living (ADL) in patients with moderate to severe Alzheimer’s disease. In patients with mild to moderate vascular dementia there is an effect only on cognition, but not on the ADL and clinical impression of change. In patients with moderate to severe Alzheimer, the clinical effect is moderate, equal to the effect of cholinesterase inhibitors. Conclusions Memantin has a valuable place in the current clinical management of moderate to severe dementia. There is however a need to address certain ethical questions. None of the studies measures impact on quality of life and life expectancy. Expensive drugs must not reduce other “simpler” treatments involving human contact.