The action of memantine on the cognitive disorders of patients with dementia:: Reflections following two years' experience in Spain

Aims. To review the literature on the effectiveness of memantine in cognitive disorders, and to discuss data from our own personal experience. Development. In moderately advanced or advanced stages of Alzheimer's disease (AD), use of memantine for cognitive disorders and functional independence is significantly effective, regardless of whether anticholinesterases are taken or not. Effectiveness lasts at least I year (open trial). The NNT (number needed to treat) of 7 means it has a value that is similar to that of anticholinesterases for the treatment of the early or moderate phases and the magnitude effect of 0.47 can be graded as intermediate. In incipient or moderate AD its effectiveness on the cognitive functions is lower In early or moderate vascular dementia, memantine has favourable effects with regard to cognition, especially in dementia due to 'small-vessel' disease, although this is not reflected in functional independence, probably because it is also affected by other neurological and systemic factors. A retrospective analysis of 43 of our own cases (AD at GDS 6-7) showed a percentage of 'not worse' between successive visits (mean interval of 6 months) of 40-70%, the best result being obtained by those who take anticholinesterase. Conclusions. The effectiveness of memantine on cognitive impairment is significant in moderately advanced and advanced stages of AD, although we need to know physicians' impressions in order to determine the extent to which the first expectations from clinical trials are confirmed This effect is less pronounced in the early and intermediate stages and in vascular dementia.