Abstract

EFFECTIVENESS OF COMBINATION THERAPY MEMANTINE WITH CHOLINESTERASE INHIBITORS FOR IMPROVING COGNITION, BEHAVIOUR AND QUALITY OF LIFE IN DEMENTIA PATIENTS

Jovina Merin Sam*, Blessy, Ammu Godwin, Prof. Dr. Lincy Joseph, Dr. Sheetal S. and Dr. Santhosh M. Mathews

ABSTRACT

Dementia is the collection of signs and symptoms such as memory problems, communication difficulties, difficulties with organizing and planning one’s day-to-day life, changes in mood and behaviour, and the gradual loss of control of physical functions. Age is the primary risk factor for developing dementia. The two drug classes currently available for the treatment of AD are the uncompetitive NMDA receptor antagonist, memantine (which normalises dysfunctional glutamatergic neurotransmission), and acetylcholinesterase inhibitors (AChEIs: donepezil, galantamine and rivastigmine, which all raise ACh levels). A prospective observational study was conducted at the tertiary care setting of Pushpagiri Medical College Hospital in the Department of Neuro Medicine. The study was conducted to compare the effectiveness of combination therapy consisting of cholinesterase inhibitor- donepezil 5mg and memantine 5 mg, over monotherapy consisting of cholinesterase inhibitor- donepezil 5 mg alone, for dementia patients by assessing parameters such as cognition, behaviour and quality of life with tools like GPCOG, Mini-COG, MIS, QOL-AD and KSBA. Patients will be assessed with these tools after undergoing 3 months of monotherapy and subsequently assessed again after three months from switching to combination therapy. About 74 patients were enrolled for 6-month study period. The results showed significant improvement in cognition, quality of life and behavioral function, of combination therapy over monotherapy, with differences in mean value for the scales for both as follows. GPCOG– 2.89, P- value – 0.0001, Mini-COG– 1.26, P-value – 0.0001, MIS- 3.71, P- value – 0.0001, QOL-AD- 12.07, P- value – 0.0001, KSBA- 11.33, P- value – 0.0001. From the results obtained we conclude that the combination therapy using cholinesterase inhibitors and memantine produced statistically significant improvement in the primary and secondary objectives of parameters- cognition, quality of life and behavior at the end of 3 months, than that obtained with monotherapy using cholinesterase inhibitors alone for 3 months. Thus, combination therapy using cholinesterase inhibitors and memantine over monotherapy (cholinesterase inhibitors alone) were more preferred for the treatment of dementia.

Keywords: N- methyl-D- aspartate receptor antagonist (NMDA), acetyl cholinesterase inhibitors (AchEI), General Practioner Cognitive Assessment (GPCOG), Mini-COG, Memory Impairment Screening (MIS),Quality of Life Alzheimer’s Disease (QOL-AD), Kingston’s Standardised