TY - JOUR
T1 - Memantine discontinuation and the health status of nursing home residents with alzheimer's disease
AU - Fillit, Howard
AU - Hofbauer, Robert K.
AU - Setyawan, Juliana
AU - Tourkodimitris, Stavros
AU - Fridman, Moshe
AU - Pejović, Vojislav
AU - Miller, Michael L.
AU - Erder, M. Haim
AU - Lyketsos, Constantine
N1 - Funding Information:
Ron Weishaar, PhD, and the staff at Omnicare Clinical Research (King of Prussia, PA) participated in protocol consultations and data collection. E. Malca Resnick, PhD, participated in the study conceptualization/design, conduct, and initial analyses. This study was sponsored by Forest Laboratories, Inc , which included providing financial, material, and statistical support.
PY - 2010/11
Y1 - 2010/11
N2 - Objective: To estimate the effect of memantine discontinuation for a nonmedical reason (eg, formulary restriction or family decision) on the health status of nursing home (NH) residents with Alzheimer's disease (AD). Design: Retrospective chart review. Setting: NHs (n = 113) in the United States. Participants: Residents (minimum stay of 90 days) with AD, continuously treated with memantine (MC: n = 273) or discontinued for 60 days or longer (MD: n = 248). The subset of patients who discontinued for a nonmedical reason (MD-N: n = 163) was also analyzed, as was the subset of patients in groups MC and MD-N whose doses of concomitant medications remained stable (MCs: n = 185; MD-Ns: n = 70). Measurements: Thirty-one common geriatric and AD symptoms from NH charts were scored based on their emergence or resolution (+1 or -1 points, respectively), worsening or improvement (+0.5 or -0.5 points, respectively), or absence of change (0 points), compared with the baseline period (the first 30 days analyzed in the charts, during which all residents received memantine treatment). Patients' weight change was also captured. Results: Compared with continuous treatment, memantine discontinuation was associated with a significant increase in the Total AD Symptom Change Score (ie, worsening) in all comparison pairs (MC versus MD, MC versus MD-N, and MCs versus MD-Ns: P < .001 for all). The symptoms showing greatest worsening aggregated into two factors: cognition and mood. Conclusion: 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.
AB - Objective: To estimate the effect of memantine discontinuation for a nonmedical reason (eg, formulary restriction or family decision) on the health status of nursing home (NH) residents with Alzheimer's disease (AD). Design: Retrospective chart review. Setting: NHs (n = 113) in the United States. Participants: Residents (minimum stay of 90 days) with AD, continuously treated with memantine (MC: n = 273) or discontinued for 60 days or longer (MD: n = 248). The subset of patients who discontinued for a nonmedical reason (MD-N: n = 163) was also analyzed, as was the subset of patients in groups MC and MD-N whose doses of concomitant medications remained stable (MCs: n = 185; MD-Ns: n = 70). Measurements: Thirty-one common geriatric and AD symptoms from NH charts were scored based on their emergence or resolution (+1 or -1 points, respectively), worsening or improvement (+0.5 or -0.5 points, respectively), or absence of change (0 points), compared with the baseline period (the first 30 days analyzed in the charts, during which all residents received memantine treatment). Patients' weight change was also captured. Results: Compared with continuous treatment, memantine discontinuation was associated with a significant increase in the Total AD Symptom Change Score (ie, worsening) in all comparison pairs (MC versus MD, MC versus MD-N, and MCs versus MD-Ns: P < .001 for all). The symptoms showing greatest worsening aggregated into two factors: cognition and mood. Conclusion: 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.
KW - Chart review
KW - Memantine
KW - Nursing home
KW - Treatment discontinuation
UR - https://www.scopus.com/pages/publications/77958453592
U2 - 10.1016/j.jamda.2009.12.086
DO - 10.1016/j.jamda.2009.12.086
M3 - Article
AN - SCOPUS:77958453592
SN - 1525-8610
VL - 11
SP - 636-644.e1
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 9
ER -