MEMANTINE DISCONTINUATION AND THE HEALTH STATUS OF NURSING HOME RESIDENTS WITH ALZHEIMER'S DISEASE. Fillit HM, Hofbauer RK, et al: Journal of the American Medical Directors Association, 2010; 11 (November) 636-644
OBJECTIVE: To estimate the effect of memantine (Namenda®) discontinuation for a nonmedical reason (e.g., formulary restriction or family decision) on the health status of nursing home (NH) residents with Alzheimer's disease (AD).
DESIGN: Retrospective chart review.
RESULTS: Compared with continuous treatment, memantine discontinuation was associated with a significant increase in the Total AD Symptom Change Score (i.e., worsening) in all comparison pairs. The symptoms showing greatest worsening aggregated into two factors: cognition and mood.
CONCLUSIONS: Memantine discontinuation in NH residents with AD may be associated with declining health status, and should be considered with care. A randomized, placebo-controlled trial of treatment discontinuation is merited.
KEVIN’S COMMENTS: Memantine is indicated for the treatment of moderate to severe Alzheimer’s disease. Several clinical studies have demonstrated in such persons a favorable effect on cognition, behaviors such as agitation and aggression, and activities of daily living. However, we can expect that nonmedical reasons for discontinuing medications in nursing home residents will escalate as budgetary concerns and perceived lack of benefit surface. This study showed that sudden withdrawal of memantine in persons with moderate to advanced Alzheimer’s disease resulted in a decline in overall health status within 2-3 months, compared with continued memantine treatment.
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