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Memantine and Comprehensive, Individualized Management of Alzheimer's Disease and Caregiver Training

Memantine and Comprehensive, Individualized, Patient Centered Management of Alzheimer's Disease: A Randomized Controlled Trial

Status
Completed
Phases
Phase 4
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00120874
Enrollment
20
Registered
2005-07-19
Start date
2006-08-31
Completion date
2011-11-30
Last updated
2016-10-25

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Alzheimer's Disease

Keywords

Alzheimer's disease, caregiver training, caregiver counseling, individualized management, memantine, dementia

Brief summary

The purpose of this study is to determine whether a comprehensive, individualized management approach with caregiver training and medication with memantine will alleviate symptoms in community dwelling patients with moderate to severe Alzheimer's disease.

Detailed description

Presently some 4.5 million people are afflicted with Alzheimer's disease in the United States. At present pharmacologic treatment, although beneficial, is not curative. Certain nonpharmacologic treatments have assisted caregivers of AD patients by reducing their stress and burden, and others have aided patients, by improving their mood and physical functioning. Comprehensive, individualized approaches to improving Alzheimer's patients' symptomatology and caregiver stress and burden have not been systematically investigated in Alzheimer's patient care. This study seeks to train and counsel caregivers as well as develop an individualized, comprehensive management program that will seek to enhance the functioning of each patient participant. Patients are randomly placed into one of two groups. Both groups receive memantine and comprehensive evaluations at baseline, 4, 12,28 and 52 weeks. Additionally, group 1 receives an individualized management program, which consists of home visits to get the patient exercising, doing enjoyable activities and cognitive stimulation, educational sessions for caregivers on coping with difficult situations and a caregiver support group to help with questions and emotional concerns.

Interventions

BEHAVIORALIndividualized management of AD including caregiver training

Individualized management program: consists of home visits to get the patient exercising, doing enjoyable activities and cognitive stimulation, educational sessions for caregivers on coping with difficult situations and a caregiver support group to help with questions and emotional concerns.

DRUGMemantine

Patients receive 10 milligrams of memantine twice daily.

Sponsors

Forest Laboratories
CollaboratorINDUSTRY
Fisher Center for Alzheimer's Research Foundation
CollaboratorOTHER
NYU Langone Health
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Masking
SINGLE (Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
50 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Patients, 50 years of age or greater, residing in the community * Presence of a family and/or professional caregiver willing and able to participate in all aspects of this study * A diagnosis of probable Alzheimer's disease by Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) and NINCDS-ADRDA (McKhann,et al., Neurology,1984;34: 939-944) criteria * A CT or MRI brain scan and medical work up compatible with the DSM-IV and NINCDS-ADRDA diagnostic criteria for Alzheimer's disease * Mini-Mental State Examination scores of 3-14 * Global Deterioration Scale stages of 5 or 6 * A stage of 6a or greater on the Functional Assessment Staging instrument signifying the presence of dementia deficits in the ability to perform one or more basic activities of daily living

Exclusion criteria

* Non-English speaking patients and/or caregivers * Subjects with a diagnosis of dementia due to conditions other than Alzheimer's disease. * Subjects with a diagnosis of vascular dementia or a score greater than 4 on the modified Hachinski Ischemic Rating scale * Patients with a major depressive disorder * Patients with clinically significant laboratory abnormalities * Patients receiving investigational pharmacologic agents

Design outcomes

Primary

MeasureTime frameDescription
Change From Baseline in Clinician Interview-Based Assessment of Change Plus Caregiver Input (CIBIC-Plus) Global Score (New York Univeristy Version)Baseline to 28 weeksCIBIC-Plus is measured in units on a scale ranging from 1 to 7, where 1 is markedly improved, 4 is unchanged, and 7 is markedly worse
Change From Baseline of The Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory Modified for Severe Dementia Abbreviated Version (ADCS-ADLsev-abv)Baseline to 28 weeksThe ADCS-ADLsev-abv is a structured questionnaire where each item consists of a series of hierarchical questions designed to determine a patient's ability to perform the activities of daily living as assessed by the caregiver. Possible scores range from 0 to 39, where a higher score is indicative of greater capacities.

Secondary

MeasureTime frameDescription
Change From Baseline of the Functional Assessment Staging Disability Score (FAST-DS)Baseline to 28 weeksThe FAST-DS assesses the magnitude of progressive functional deterioration by identifying characteristic progressive disabilities in participants with AD. Scores range from 1.0 (normal) to 7f (severe loss of ability, not even able to hold up head independently). Scores are made up of stages (1 through 7) and substages (from a to e for stage 6; from a to f for stage 7). The following scoring for substages is applied: 6a=6.0, 6b=6.2, 6c=6.4, 6d=6.6, 6e=6.8, 7a=7.0, 7b=7.2, 7c=7.4, 7d=7.6, 7e=7.8, 7f=8.0. Additionally, non-consecutive deficits are noted and scored as follows: full stage non-consecutive deficit=1.0, non-consecutive substage deficit=0.2. The overall FAST-DS score = (FAST Stage Score) + (Each Non-Consecutive FAST disability scored as described)
Change From Baseline of The Behavioral Pathology in Alzheimer's Disease Frequency Weighted Severity Scale (BEHAVE-AD-FW)Baseline to 28 weeksThe BEHAVE-AD-FW measures the frequency and severity of 25 behavioral symptoms with a total score and global rating. Individual behavioral assessments are rated for severity (0=none to 3-most severe) and frequency (1=least frequent to 4=most frequent) which are then multiplied; scores for each of the 25 items are then summed. Possible total scores range from 0 to 297. The global rating is scored from 0 (not dangerous to patient, not troubling to caregiver) to 3 (dangerous to patient, highly troubling to caregiver). Global rating was not analyzed for this study. The higher the score the worse the outcome.
Change From Baseline of the Severe Impairment Battery (SIB)Baseline to 28 weeksThe SIB evaluates cognitive performance. It is a 51 item scale which assesses social interaction, memory, language, orientation, attention, praxis, visuospacial ability and construction. Scores range from 0 (greatest impairment) to 100 (least impairment).
Change From Baseline of the Revised Memory and Behavior Problems Checklist (RMBPC): Caregiver ReactionBaseline to 28 weeksThe RMBPC is a 24 item rating scale of the frequency of memory and behavioral problems in the AD subject and of how upset or bothered their caregivers react. Frequency is rated from 0 (least frequent) to 4 (most frequent) and caregiver reaction is rated from 0 (not at all) to 4 (extremely bothered or upset). Higher scores indicate more frequent memory and behavioral problems in the subject with AD as well as a more upset or bothered caregiver. Possible scores range from 0 to 96.
Change From Baseline of the Revised Memory and Behavior Problems Checklist (RMBPC): FrequencyBaseline to 28 weeksThe RMBPC is a 24 item rating scale of the frequency of memory and behavioral problems in the AD subject and of how upset or bothered their caregivers react. Frequency is rated from 0 (least frequent) to 4 (most frequent) and caregiver reaction is rated from 0 (not at all) to 4 (extremely bothered or upset). Higher scores indicate more frequent memory and behavioral problems in the subject with AD as well as a more upset or bothered caregiver. Possible scores range from 0 to 96.
Change From Baseline of the Mini-Mental State Examination (MMSE)Baseline to 28 weeksThe MMSE is a graded on a 30 point scale that measures cognitive functioning. A lower score indicates a higher level of impairment. Complete scale range is -no cognitive impairment=24-30; mild cognitive impairment=18-23; severe cognitive impairment=0-17.

Countries

United States

Participant flow

Participants by arm

ArmCount
Individualized Management and Memantine
Individualized Management including caregiver training and Memantine Individualized management of AD including caregiver training: Individualized management program: consists of home visits to get the patient exercising, doing enjoyable activities and cognitive stimulation, educational sessions for caregivers on coping with difficult situations and a caregiver support group to help with questions and emotional concerns. Memantine: Patients receive 10 milligrams of memantine twice daily.
10
Memantine
Only Memantine Memantine: Patients receive 10 milligrams of memantine twice daily.
10
Total20

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyDeath01

Baseline characteristics

CharacteristicIndividualized Management and MemantineMemantineTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
9 Participants10 Participants19 Participants
Age, Categorical
Between 18 and 65 years
1 Participants0 Participants1 Participants
Race/Ethnicity, Customized
Hispanic-American
0 participants2 participants2 participants
Race/Ethnicity, Customized
White, not of Hispanic-American Origin
10 participants8 participants18 participants
Sex: Female, Male
Female
8 Participants7 Participants15 Participants
Sex: Female, Male
Male
2 Participants3 Participants5 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
10 / 1010 / 10
serious
Total, serious adverse events
3 / 1010 / 10

Outcome results

Primary

Change From Baseline in Clinician Interview-Based Assessment of Change Plus Caregiver Input (CIBIC-Plus) Global Score (New York Univeristy Version)

CIBIC-Plus is measured in units on a scale ranging from 1 to 7, where 1 is markedly improved, 4 is unchanged, and 7 is markedly worse

Time frame: Baseline to 28 weeks

ArmMeasureValue (MEAN)Dispersion
Memantine + CIPCM ProgramChange From Baseline in Clinician Interview-Based Assessment of Change Plus Caregiver Input (CIBIC-Plus) Global Score (New York Univeristy Version)2.3 units on a scaleStandard Deviation 1.16
Memantine AloneChange From Baseline in Clinician Interview-Based Assessment of Change Plus Caregiver Input (CIBIC-Plus) Global Score (New York Univeristy Version)5.22 units on a scaleStandard Deviation 1.56
Primary

Change From Baseline in Clinician Interview-Based Assessment of Change Plus Caregiver Input (CIBIC-Plus) Global Score (New York Univeristy Version)

CIBIC-Plus is measured in units on a scale ranging from 1 to 7, where 1 is markedly improved, 4 is unchanged, and 7 is markedly worse

Time frame: Baseline to 52 weeks

ArmMeasureValue (MEAN)Dispersion
Memantine + CIPCM ProgramChange From Baseline in Clinician Interview-Based Assessment of Change Plus Caregiver Input (CIBIC-Plus) Global Score (New York Univeristy Version)2.1 units on a scaleStandard Deviation 1.45
Memantine AloneChange From Baseline in Clinician Interview-Based Assessment of Change Plus Caregiver Input (CIBIC-Plus) Global Score (New York Univeristy Version)6 units on a scaleStandard Deviation 1.32
Primary

Change From Baseline of The Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory Modified for Severe Dementia Abbreviated Version (ADCS-ADLsev-abv)

The ADCS-ADLsev-abv is a structured questionnaire where each item consists of a series of hierarchical questions designed to determine a patient's ability to perform the activities of daily living as assessed by the caregiver. Possible scores range from 0 to 39, where a higher score is indicative of greater capacities.

Time frame: Baseline to 28 weeks

ArmMeasureValue (MEAN)Dispersion
Memantine + CIPCM ProgramChange From Baseline of The Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory Modified for Severe Dementia Abbreviated Version (ADCS-ADLsev-abv)21.9 units on a scaleStandard Deviation 8.034
Memantine AloneChange From Baseline of The Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory Modified for Severe Dementia Abbreviated Version (ADCS-ADLsev-abv)9.6 units on a scaleStandard Deviation 6.041
Primary

Change From Baseline of The Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory Modified for Severe Dementia Abbreviated Version (ADCS-ADLsev-abv)

The ADCS-ADLsev-abv is a structured questionnaire where each item consists of a series of hierarchical questions designed to determine a patient's ability to perform the activities of daily living as assessed by the caregiver. Possible scores range from 0 to 39, where a higher score is indicative of greater capacities.

Time frame: Baseline to 52 weeks

ArmMeasureValue (MEAN)Dispersion
Memantine + CIPCM ProgramChange From Baseline of The Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory Modified for Severe Dementia Abbreviated Version (ADCS-ADLsev-abv)18.5 units on a scaleStandard Deviation 8.045
Memantine AloneChange From Baseline of The Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory Modified for Severe Dementia Abbreviated Version (ADCS-ADLsev-abv)7.6 units on a scaleStandard Deviation 6.766
Secondary

Change From Baseline of The Behavioral Pathology in Alzheimer's Disease Frequency Weighted Severity Scale (BEHAVE-AD-FW)

The BEHAVE-AD-FW measures the frequency and severity of 25 behavioral symptoms with a total score and global rating. Individual behavioral assessments are rated for severity (0=none to 3-most severe) and frequency (1=least frequent to 4=most frequent) which are then multiplied; scores for each of the 25 items are then summed. Possible total scores range from 0 to 297. The global rating is scored from 0 (not dangerous to patient, not troubling to caregiver) to 3 (dangerous to patient, highly troubling to caregiver). The higher the score the worse the outcome.

Time frame: Baseline to 52 weeks

ArmMeasureValue (MEAN)Dispersion
Memantine + CIPCM ProgramChange From Baseline of The Behavioral Pathology in Alzheimer's Disease Frequency Weighted Severity Scale (BEHAVE-AD-FW)8.1 units on a scaleStandard Deviation 5.131
Memantine AloneChange From Baseline of The Behavioral Pathology in Alzheimer's Disease Frequency Weighted Severity Scale (BEHAVE-AD-FW)21.2 units on a scaleStandard Deviation 11.893
Secondary

Change From Baseline of The Behavioral Pathology in Alzheimer's Disease Frequency Weighted Severity Scale (BEHAVE-AD-FW)

The BEHAVE-AD-FW measures the frequency and severity of 25 behavioral symptoms with a total score and global rating. Individual behavioral assessments are rated for severity (0=none to 3-most severe) and frequency (1=least frequent to 4=most frequent) which are then multiplied; scores for each of the 25 items are then summed. Possible total scores range from 0 to 297. The global rating is scored from 0 (not dangerous to patient, not troubling to caregiver) to 3 (dangerous to patient, highly troubling to caregiver). Global rating was not analyzed for this study. The higher the score the worse the outcome.

Time frame: Baseline to 28 weeks

ArmMeasureValue (MEAN)Dispersion
Memantine + CIPCM ProgramChange From Baseline of The Behavioral Pathology in Alzheimer's Disease Frequency Weighted Severity Scale (BEHAVE-AD-FW)7.2 units on a scaleStandard Deviation 5.308
Memantine AloneChange From Baseline of The Behavioral Pathology in Alzheimer's Disease Frequency Weighted Severity Scale (BEHAVE-AD-FW)23.7 units on a scaleStandard Deviation 14.952
Secondary

Change From Baseline of the Functional Assessment Staging Disability Score (FAST-DS)

The FAST-DS assesses the magnitude of progressive functional deterioration by identifying characteristic progressive disabilities in participants with AD. Scores range from 1.0 (normal) to 7f (severe loss of ability, not even able to hold up head independently). Scores are made up of stages (1 through 7) and substages (from a to e for stage 6; from a to f for stage 7). The following scoring for substages is applied: 6a=6.0, 6b=6.2, 6c=6.4, 6d=6.6, 6e=6.8, 7a=7.0, 7b=7.2, 7c=7.4, 7d=7.6, 7e=7.8, 7f=8.0. Additionally, non-consecutive deficits are noted and scored as follows: full stage non-consecutive deficit=1.0, non-consecutive substage deficit=0.2. The overall FAST-DS score = (FAST Stage Score) + (Each Non-Consecutive FAST disability scored as described)

Time frame: Baseline to 52 weeks

ArmMeasureValue (MEAN)Dispersion
Memantine + CIPCM ProgramChange From Baseline of the Functional Assessment Staging Disability Score (FAST-DS)6.5 units on a scaleStandard Deviation 0.254
Memantine AloneChange From Baseline of the Functional Assessment Staging Disability Score (FAST-DS)6.84 units on a scaleStandard Deviation 0.279
Secondary

Change From Baseline of the Functional Assessment Staging Disability Score (FAST-DS)

The FAST-DS assesses the magnitude of progressive functional deterioration by identifying characteristic progressive disabilities in participants with AD. Scores range from 1.0 (normal) to 7f (severe loss of ability, not even able to hold up head independently). Scores are made up of stages (1 through 7) and substages (from a to e for stage 6; from a to f for stage 7). The following scoring for substages is applied: 6a=6.0, 6b=6.2, 6c=6.4, 6d=6.6, 6e=6.8, 7a=7.0, 7b=7.2, 7c=7.4, 7d=7.6, 7e=7.8, 7f=8.0. Additionally, non-consecutive deficits are noted and scored as follows: full stage non-consecutive deficit=1.0, non-consecutive substage deficit=0.2. The overall FAST-DS score = (FAST Stage Score) + (Each Non-Consecutive FAST disability scored as described)

Time frame: Baseline to 28 weeks

ArmMeasureValue (MEAN)Dispersion
Memantine + CIPCM ProgramChange From Baseline of the Functional Assessment Staging Disability Score (FAST-DS)6.16 units on a scaleStandard Deviation 0.631
Memantine AloneChange From Baseline of the Functional Assessment Staging Disability Score (FAST-DS)6.67 units on a scaleStandard Deviation 0.246
Secondary

Change From Baseline of the Mini-Mental State Examination (MMSE)

The MMSE is a graded on a 30 point scale that measures cognitive functioning. A lower score indicates a higher level of impairment. Complete scale range is -no cognitive impairment=24-30; mild cognitive impairment=18-23; severe cognitive impairment=0-17.

Time frame: Baseline to 52 weeks

ArmMeasureValue (MEAN)Dispersion
Memantine + CIPCM ProgramChange From Baseline of the Mini-Mental State Examination (MMSE)6.7 units on a scaleStandard Deviation 4.138
Memantine AloneChange From Baseline of the Mini-Mental State Examination (MMSE)6.7 units on a scaleStandard Deviation 5.477
Secondary

Change From Baseline of the Mini-Mental State Examination (MMSE)

The MMSE is a graded on a 30 point scale that measures cognitive functioning. A lower score indicates a higher level of impairment. Complete scale range is -no cognitive impairment=24-30; mild cognitive impairment=18-23; severe cognitive impairment=0-17.

Time frame: Baseline to 28 weeks

ArmMeasureValue (MEAN)Dispersion
Memantine + CIPCM ProgramChange From Baseline of the Mini-Mental State Examination (MMSE)6.7 units on a scaleStandard Deviation 5.143
Memantine AloneChange From Baseline of the Mini-Mental State Examination (MMSE)8.4 units on a scaleStandard Deviation 5.816
Secondary

Change From Baseline of the Revised Memory and Behavior Problems Checklist (RMBPC): Caregiver Reaction

The RMBPC is a 24 item rating scale of the frequency of memory and behavioral problems in the AD subject and of how upset or bothered their caregivers react. Frequency is rated from 0 (least frequent) to 4 (most frequent) and caregiver reaction is rated from 0 (not at all) to 4 (extremely bothered or upset). Higher scores indicate more frequent memory and behavioral problems in the subject with AD as well as a more upset or bothered caregiver. Possible scores range from 0 to 96.

Time frame: Baseline to 52 weeks

ArmMeasureValue (MEAN)Dispersion
Memantine + CIPCM ProgramChange From Baseline of the Revised Memory and Behavior Problems Checklist (RMBPC): Caregiver Reaction3.8 units on a scaleStandard Deviation 6.68
Memantine AloneChange From Baseline of the Revised Memory and Behavior Problems Checklist (RMBPC): Caregiver Reaction11.4 units on a scaleStandard Deviation 11.599
Secondary

Change From Baseline of the Revised Memory and Behavior Problems Checklist (RMBPC): Caregiver Reaction

The RMBPC is a 24 item rating scale of the frequency of memory and behavioral problems in the AD subject and of how upset or bothered their caregivers react. Frequency is rated from 0 (least frequent) to 4 (most frequent) and caregiver reaction is rated from 0 (not at all) to 4 (extremely bothered or upset). Higher scores indicate more frequent memory and behavioral problems in the subject with AD as well as a more upset or bothered caregiver. Possible scores range from 0 to 96.

Time frame: Baseline to 28 weeks

ArmMeasureValue (MEAN)Dispersion
Memantine + CIPCM ProgramChange From Baseline of the Revised Memory and Behavior Problems Checklist (RMBPC): Caregiver Reaction2.0 units on a scaleStandard Deviation 2.582
Memantine AloneChange From Baseline of the Revised Memory and Behavior Problems Checklist (RMBPC): Caregiver Reaction10.7 units on a scaleStandard Deviation 14.143
Secondary

Change From Baseline of the Revised Memory and Behavior Problems Checklist (RMBPC): Frequency

The RMBPC is a 24 item rating scale of the frequency of memory and behavioral problems in the AD subject and of how upset or bothered their caregivers react. Frequency is rated from 0 (least frequent) to 4 (most frequent) and caregiver reaction is rated from 0 (not at all) to 4 (extremely bothered or upset). Higher scores indicate more frequent memory and behavioral problems in the subject with AD as well as a more upset or bothered caregiver. Possible scores range from 0 to 96.

Time frame: Baseline to 28 weeks

ArmMeasureValue (MEAN)Dispersion
Memantine + CIPCM ProgramChange From Baseline of the Revised Memory and Behavior Problems Checklist (RMBPC): Frequency24.7 units on a scaleStandard Deviation 9.945
Memantine AloneChange From Baseline of the Revised Memory and Behavior Problems Checklist (RMBPC): Frequency34.9 units on a scaleStandard Deviation 9.515
Secondary

Change From Baseline of the Revised Memory and Behavior Problems Checklist (RMBPC): Frequency

The RMBPC is a 24 item rating scale of the frequency of memory and behavioral problems in the AD subject and of how upset or bothered their caregivers react. Frequency is rated from 0 (least frequent) to 4 (most frequent) and caregiver reaction is rated from 0 (not at all) to 4 (extremely bothered or upset). Higher scores indicate more frequent memory and behavioral problems in the subject with AD as well as a more upset or bothered caregiver. Possible scores range from 0 to 96.

Time frame: Baseline to 52 weeks

ArmMeasureValue (MEAN)Dispersion
Memantine + CIPCM ProgramChange From Baseline of the Revised Memory and Behavior Problems Checklist (RMBPC): Frequency24.4 units on a scaleStandard Deviation 8.449
Memantine AloneChange From Baseline of the Revised Memory and Behavior Problems Checklist (RMBPC): Frequency32.4 units on a scaleStandard Deviation 11.4
Secondary

Change From Baseline of the Severe Impairment Battery (SIB)

The SIB evaluates cognitive performance. It is a 51 item scale which assesses social interaction, memory, language, orientation, attention, praxis, visuospacial ability and construction. Scores range from 0 (greatest impairment) to 100 (least impairment).

Time frame: Baseline to 28 weeks

ArmMeasureValue (MEAN)Dispersion
Memantine + CIPCM ProgramChange From Baseline of the Severe Impairment Battery (SIB)51.3 units on a scaleStandard Deviation 33.843
Memantine AloneChange From Baseline of the Severe Impairment Battery (SIB)54 units on a scaleStandard Deviation 37.002
Secondary

Change From Baseline of the Severe Impairment Battery (SIB)

The SIB evaluates cognitive performance. It is a 51 item scale which assesses social interaction, memory, language, orientation, attention, praxis, visuospacial ability and construction. Scores range from 0 (greatest impairment) to 100 (least impairment).

Time frame: Baseline to 52 weeks

ArmMeasureValue (MEAN)Dispersion
Memantine + CIPCM ProgramChange From Baseline of the Severe Impairment Battery (SIB)45.1 units on a scaleStandard Deviation 33.365
Memantine AloneChange From Baseline of the Severe Impairment Battery (SIB)48 units on a scaleStandard Deviation 37.353

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026