Memantine is recommended for patients with mild to moderate vascular dementia.
The recommendation is strong because of positive effect on patient important outcomes such as slight improvement in daily activities, behaviour and mood.. Memantine is well tolerated and the cost is low.
A Cochrane review [Abstract] 1 included 2 studies with a total of 750 subjects with mild to moderate vascular dementia. Moderate- and low-certainty evidence indicates there is probably a small clinical benefit for cognitive function: 2.15 ADAS-Cog points (95% CI 1.05 to 3.25); there may be a small clinical benefit for behaviour and mood: 0.47 NOSGER disturbing behaviour points (95% CI 0.07 to 0.87); there is probably no difference in clinical global rating: 0.03 CIBIC+ points (95% CI -0.28 to 0.34); and there may be no difference in activities of daily living: 0.11 NOSGER II self-care subscale points (95% CI -0.35 to 0.54) or in the numbers of people discontinuing treatment: RR 1.05 (95% CI 0.83 to 1.34).
Memantine was well tolerated. There is high-certainty evidence showing no difference between memantine and placebo in the proportion experiencing at least one adverse event: RR 1.03 (95% CI 1.00 to 1.06); the RR does not differ between aetiologies or severities of dementia. Combining available data from all trials, there is moderate-certainty evidence that memantine is 1.6 times more likely than placebo to result in dizziness (6.1% versus 3.9%), low-certainty evidence of a 1.3-fold increased risk of headache (5.5% versus 4.3%), but high-certainty evidence of no difference in falls.
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