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P4‐342: Only mild cognitive impairment/Alzheimer's disease shows a significant cognitive improvement receiving combined antidementive treatment
Author(s) -
Peters Oliver,
Lorenz Doreen,
Möller Hans-Jürgen,
Frölich Lutz,
Heuser Isabella
Publication year - 2008
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2008.05.2412
Subject(s) - discontinuation , memantine , medicine , placebo , dementia , etiology , cognitive decline , alzheimer's disease , cognitive impairment , disease , pediatrics , pathology , alternative medicine
Background: Mild cognitive impairment (MCI) may represent early stages of different neurodegenerative diseases. The majority of the amnestic subtype (aMCI) is thought to represent a prodromal stage of Alzheimers disease (AD). Methods: In a double-blinded placebo-controlled study 237 aMCI were randomized to receive a combination therapy of Galantamin plus Memantine (Gal/Mem), Galantamine alone (Gal) or placebo (Plc). The study was prematurely stopped during recruitment for safety reasons, at that time aMCI were treated between 56-346 days. ADAS-cog was repetitively administered while patients received study medication and after discontinuation of treatment. 83 patients were reexamined two years after study entry. Results: Analyzes of the etiologies underlying the aMCI syndrome revealed that only patients with probable AD (MCI-AD) showed a significant cognitive benefit, while other etiologies improved only moderately. Improvement in the Gal/Mem group measured by ADAS-cog exceeded the effect of treatment with Gal alone, while patients receiving Plc worsened (Gal/Mem: 1,08 5,38, Gal: 0,29 2,67, Plc: -2 3,27; delta from baseline; six months of treatment). After discontinuation of treatment with Gal MCI-AD showed a significant cognitive decline (MCIall: -1,82 4,85, MCI-AD: -2,67 3,5, delta from the beginning of discontinuation). Discontinuation of Mem showed no immediate worsening in ADAS-cog within one week. Two years after the study was started 15% of aMCI had converted to dementia, all of them belonged to the MCI-AD subgroup and the majority of converters was positive for APOE 4. Conclusions: We conclude that only MCI-AD show a significant cognitive improvement and the combination therapy (Gal/ Mem) exceeded the monotherapy (Gal). The potential influence of combined treatment on the conversion rate in aMCI could not be tested because of premature discontinuation.