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Changes in Nursing Burden Following Memantine for Agitation and Aggression in Long-Term Care Residents with Moderate to Severe Alzheimer’s Disease

An Open-Label Pilot Study

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Abstract

Background: Agitation and aggression are common neuropsychiatric symptoms of Alzheimer’s disease (AD) with a negative impact on caregivers.

Objective: The aim of the study was to determine whether changes in agitation and aggression would follow memantine treatment and, if so, be associated with changes in nursing burden in institutionalized patients with moderate to severe AD.

Study Design: This was a 3-month open-label trial of memantine.

Setting: The setting was two long-term care facilities.

Patients: Thirty-one institutionalized patients with moderate to severe AD and significant behavioural and psychiatric symptoms were included in the study.

Intervention: Memantine was titrated to a target dose of 10mg twice daily.

Main Outcome Measure: Effectiveness was assessed by the change in the Neuropsychiatric Inventory-Nursing Home (NPI-NH) agitation/aggression subscale and Clinical Global Impression of Change (CGI-C) scale using the intent-to-treat population. To establish caregiver impact, the effect on nursing burden was measured by the Modified Nursing Care Assessment Scale (primary outcome). As a secondary analysis, the caregiver distress subscale of the NPI-NH was examined, as well as changes in as required (pro re nata [prn]) psychotropic medication use.

Results: Twenty-four patients completed the study. A significant decrease in agitation and aggression (F-test with 3 and 90 degrees of freedom [F3.90] = 3.721, p = 0.014) was demonstrated following memantine, with 48% of patients improving (either much improved or minimally improved) on the CGI-C scale. In addition, nursing burden (t-test with 30 degrees of freedom [t30] = 3.02, p = 0.005), caregiver distress (F3.90 = 4.125, p = 0.009) and the use of prn psychotropics decreased following memantine treatment (Z = −1.99, p = 0.046). Fourteen patients experienced at least one adverse event during memantine treatment. The most common adverse event associated with treatment was somnolence (n = 5).

Conclusion: The results of this study suggest that the decreased agitated and aggressive behaviour in institutionalized patients with moderate to severe AD following treatment with memantine was accompanied by improvements in nursing burden and decreased psychotropic use. These findings should be confirmed in a larger, controlled trial.

ClinicalTrials.gov Identifier: NCT00401167

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Acknowledgements

This research was supported by Lundbeck Canada, Inc. as an Investigator Initiated Trial. Dr Herrmann has received research support, consultation fees and speaker’s honoraria from Pfizer, Janssen-Ortho, Novartis, Lundbeck, Wyeth and Sonexa. In addition, Dr Herrmann is a co-investigator in an ongoing memantine clinical trial (Lundbeck Canada-NCT00857649). Jaclyn Cappell and Dr Eryavec have no conflicts of interest to declare. Dr Lanctôt has received research support, consultation fees and speaker’s honoraria from Abbott, Pfizer, Janssen-Ortho, Lundbeck, Wyeth and Sonexa.

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Authors and Affiliations

  1. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

    Nathan Herrmann &  Krista L. Lanctôt

  2. Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room FG05, Toronto, Ontario, Canada, M4N 3M5

    Nathan Herrmann, Jaclyn Cappell &  Krista L. Lanctôt

  3. North York General Hospital, Toronto, Ontario, Canada

    Goran M. Eryavec

  4. Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada

    Krista L. Lanctôt

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  1. Nathan Herrmann
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  2. Jaclyn Cappell
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  3. Goran M. Eryavec
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  4. Krista L. Lanctôt
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Correspondence to Krista L. Lanctôt.

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Herrmann, N., Cappell, J., Eryavec, G.M. et al. Changes in Nursing Burden Following Memantine for Agitation and Aggression in Long-Term Care Residents with Moderate to Severe Alzheimer’s Disease. CNS Drugs 25, 425–433 (2011). https://doi.org/10.2165/11588160-000000000-00000

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  • DOI: https://doi.org/10.2165/11588160-000000000-00000

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