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Memantine may affect pseudobulbar affect in patients with Alzheimer's disease

Published online by Cambridge University Press:  24 April 2013

Tatjana Prokšelj ,
Aleš Jerin  and
Aleš Kogoj
Tatjana Prokšelj
Affiliation:
General Hospital Novo mesto, Neuropsychiatric Department, Novo mesto, Slovenia
Aleš Jerin
Affiliation:
Institute of Clinical Chemistry and Biochemistry, University Medical Center Ljubljana, Slovenia
Aleš Kogoj*
Affiliation:
University Psychiatric Hospital Ljubljana, Gerontopsychiatric Department, Ljubljana, Slovenia
*
Aleš Kogoj, University Psychiatric Hospital Ljubljana, Gerontopsychiatric Department, Studenec 48, 1260 Ljubljana, Slovenia. Tel: +386 1 5872 506; +386 1 5872 487; Fax: +386 1 5872 590; E-mail: ales.kogoj@psih-klinika.si
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Abstract

Objective

Behavioural symptoms are common in moderate to severe Alzheimer's disease (AD) and are improved by memantine with the most pronounced effect on agitation/aggression. Dextromethorphan in combination with quinidine is the only drug approved by US Food and Drug Administration for the treatment of pseudobulbar affect (PBA) on the basis of efficacy in patients with multiple sclerosis or amyotrophic lateral sclerosis. The aim of our study was to evaluate the efficacy of memantine on PBA in patients with AD.

Methods

In a prospective, double-blind, case-control study to assess PBA with pathological laughter and crying scale patients were administered memantine (final dose of 20 mg daily) or citalopram (20 mg once daily), each for 10 weeks. The number of episodes of involuntary emotional expression, Neuropsychiatric Inventory (NPI) and Overt Aggression Scale-Modified (OAS-M) total scores were also recorded. Furthermore, the platelet serotonin (5-HT) concentration was measured.

Results

Although memantine had beneficial effects on PBA, it also had a crucial impact on behavioural symptoms, especially aggression and agitation (to an average of 3.5 times higher end-point scores on OAS-M and increase of NPI total scores for an average of 114% of initial value). Therefore, the study was prematurely stopped. In addition, we had evidenced a drop of platelet 5-HT concentration (to an average of 73% of initial value).

Conclusion

Surprisingly, our research showed the opposite action of memantine on neuropsychiatric symptoms as expected. In a limited number of AD patients with PBA, memantine had a beneficial effect on involuntary emotional expression, but it potentiated agitation/aggression, irritability and caused a crucial drop of the platelet 5-HT concentration.

Keywords

affective symptomsaggressionemotional disturbancesmemantineserotonin
Type
Original Articles
Information
Acta Neuropsychiatrica , Volume 25 , Issue 6 , December 2013 , pp. 361 - 366
Copyright
Copyright © Scandinavian College of Neuropsychopharmacology 2013 

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