P3-302: Effect of memantine on improving bpsd in Alzheimer's patients may be due to a cognitive effect as assessed with behave-ad-fw: The osaki-tajiri project

We previously investigated the possible neurological background of the Biological and Psychological Symptoms of Dementia (BPSD) in Alzheimer's disease (AD), as assessed with BEHAVE-AD-FW, and found that only “behavioral symptoms” were associated with cognitive function (attention) (J Clin Neurosci 2007). The data suggests that BPSD reflects two independent processes: one is “behavioral symptoms”, and overlaps partly with attention, and the other is “psychological symptoms”, which is unrelated to cognitive deterioration. While cholinesterase inhibitors, such donepezil which can delay the cognitive decline, memantine has been reported to “improve BPSD.” However, the possible underlying effect on cognitive deterioration has not yet been fully investigated. Consecutive outpatients at the Tajiri Clinic from 2013-2014 with medical records available describing administration of memantine 15-20 mg/d and/or donepezil 5-10 mg/d were included in a retrospective analysis. The entry criteria were a diagnosis of AD dementia (DSM-IV and NINCDS-ADRDA) and medical treatment for more than 3 months. Cognitive functions were assessed with the Cognitive Abilities Screening Instrument (CASI) and BPSD was evaluated with BEHAVE-AD-FW. At the time of abstract submission, the medical records of 12 patients were analyzed. Six patients showed improvement of BEHAVE-AD subscore C (Abnormal Behavior C), and the patients exhibited cognitive stability for the CASI domain Attention with combined administration of the two drugs. The remaining six patients showed various BPSD and cognitive deterioration, and the effect of combined administration was not remarkable. We found that a combined administration of memantine and donepezil had an effect on “BPSD” in patients, but this may have been due to improvement of cognitive function. BPSD should not be assessed as a whole symptom but evaluated with behavioral and psychological symptoms considered separately. Thus, BEHAVE-AD was recommended in the assessment of these symptoms.