Efficacy of Memantine in Behavioural and Psychological Symptoms of
Vascular Dementia: A Review
Abstract
Background: Behavioural and psychological symptoms of dementia (BPSD)
are highly distressing manifestations that are frequently experienced in
patients with vascular dementia (VaD). BPSD are difficult to manage,
associated with poorer patient outcomes, and have a profound impact on
caregivers. Glutamatergic neurotoxicity has been suggested to contribute
to the pathogenesis of BPSD. Memantine is a moderate-affinity,
uncompetitive glutamate N-methyl-D-aspartate receptor antagonist, which
has been shown to have neuroprotective properties. At present, memantine
is not licensed for treatment of BPSD in VaD. Objectives: Systematically
analyse the data on memantine to assess its clinical efficacy and safety
in the treatment of BPSD in VaD. Results: Two RCTs, comprising of 460
patients treated with memantine and 441 patients treated with placebo
that met the criteria for probable VaD, were included. Memantine showed
improvements in the Alzheimer’s Disease Assessment Scale, cognitive
subscale (ADAS-Cog), Gottfries-Brane-Steen (GBS) Scale, Nurses’
Observation Scale for Geriatric Patients (NOSGER), Mini-Mental State
Examination (MMSE), Clinical Global Impression of Change (CGIC) and
adverse events, although not all findings were statistically
significant. Conclusion: Memantine appeared to be beneficial in
improving BPSD in VaD patients and demonstrated a good safety profile.
There is currently limited literature available to support its use in
clinical practice. Therefore, further studies comprising of larger
sample sizes and patients with different VaD severities are required to
gain better understanding of the efficacy of memantine in VaD.