Memantine and constraint‐induced aphasia therapy in chronic poststroke aphasia

Objective We conducted a randomized, double‐blind, placebo‐controlled, parallel‐group study of both memantine and constraint‐induced aphasia therapy (CIAT) on chronic poststroke aphasia followed by an open‐label extension phase. Methods Patients were randomized to memantine (20mg/day) or placebo alone during 16 weeks, followed by combined drug treatment with CIAT (weeks 16–18), drug treatment alone (weeks 18–20), and washout (weeks 20–24), and finally, an open‐label extension phase of memantine (weeks 24–48). After baseline evaluations, clinical assessments were done at two end points (weeks 16 and 18), and at weeks 20, 24, and 48. Outcome measures were changes in the Western Aphasia Battery‐Aphasia Quotient and the Communicative Activity Log. Results Twenty‐eight patients were included, and 27 completed both treatment phases. The memantine group showed significantly better improvement on Western Aphasia Battery‐Aphasia Quotient compared with the placebo group while the drug was taken (week 16, p = 0.002; week 18, p = 0.0001; week 20, p = 0.005) and at the washout assessment ( p = 0.041). A significant increase in Communicative Activity Log was found in favor of memantine‐CIAT relative to placebo‐CIAT (week 18, p = 0.040). CIAT treatment led to significant improvement in both groups ( p = 0.001), which was even greater under additional memantine treatment ( p = 0.038). Beneficial effects of memantine were maintained in the long‐term follow‐up evaluation, and patients who switched to memantine from placebo experienced a benefit ( p = 0.02). Interpretation Both memantine and CIAT alone improved aphasia severity, but best outcomes were achieved combining memantine with CIAT. Beneficial effects of memantine and CIAT persisted on long‐term follow‐up. Ann Neurol 2009;65:577–585