P‐202: Combination therapy of rivastigmine & memantine for the treatment of Alzheimer's disease: Safety, tolerability, efficacy and the caregiver's voice

Combination therapy for Alzheimer's disease with Cholinesterase inhibitors and memantine is common practice. No publication yet published on clinical & caregivers impression. To investigate safety, tolerability, efficacy and caregiver impression of Combination therapy with rivastigmine & memantine for the treatment of Alzheimer's disease (AD). Patients in our practice who were treated with combination therapy with rivastigmine and memantine were evaluated. Patients met the DSM-IV and NINCDS-ADRDA criteria for possible Alzheimer's disease. Patients included in the study were treated with rivastigmine 12 mg / day in two divided doses. Memantine was started at 5 mg /day with dinner for one month. Dose was increases monthly by 5 mg /day to a maximum of 20 mg at two divided doses with rivastigmine (same time). Family and caregivers were educated about the possible benefits, side effects of the medications and realistic expectations. At baseline and after 24 weeks of treatment, subjective cognitive improvement, MMSE, ADL, and IADL outcomes were assessed and recorded. Caregivers were asked regarding tolerability, adverse events and clinical impression. A total of 536 patients were evaluated. Average period of time patients were treated with combination therapy was 6.4 months. Average MMSE score was 18.3 (range 9 - 26). Average time of treatment before baseline with rivastigmine was 14.2 months. No caregiver / family member reported cognitive deterioration during the six months of follow up. Adverse event was reported in 72 pts (13.4%). Average MMSE declined by 0.2 points after 6 months follow up. Two hundred and fifteen caregivers (40.1%) claimed there was a noticeable cognitive improvement while on combination therapy. Better functional performance was also reported in one hundred and seven (19.9%) patients. Average ADL / IADL scores improvement was 1.2/ 2.4 points during the follow up period. None of patients stopped treatment during 6 months of treatment. Combination therapy with rivastigmine (12 mg / day) with memantine (20 mg / day) is well tolerated. No adverse event was reported. None of caregivers reported any deterioration during 6 months of treatment.