• Adam L Boxer, David S Knopman, Daniel I Kaufer, Murray Grossman, Chiadi Onyike, Neill Graf-Radford, Mario Mendez, Diana Kerwin, Alan Lerner, Chuang-Kuo Wu, Mary Koestler, Jill Shapira, Kathryn Sullivan, Kristen Klepac, Kristine Lipowski, Jerin Ullah, Scott Fields, Joel H Kramer, Jennifer Merrilees, John Neuhaus, M Marsel Mesulam, and Bruce L Miller.
• Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA. aboxer@memory.ucsf.edu
• Lancet Neurol. 2013 Feb 1;12(2):149-56.

BackgroundMemantine has been used off-label to treat frontotemporal lobar degeneration (FTD). A previous 26-week open-label study suggested a transient, modest benefit on neuropsychiatric symptoms as measured by the neuropsychiatric inventory (NPI). We aimed to determine whether memantine is an effective treatment for FTD.MethodsWe did a randomised, parallel group, double-blind, placebo-controlled trial of 20 mg memantine taken orally daily for 26 weeks in patients with FTD. Participants met Neary criteria for behavioural variant FTD (bvFTD) or semantic dementia and had characteristic brain atrophy. Use of acetylcholinesterase inhibitors was prohibited. Individuals were randomly assigned to receive either memantine or matched placebo tablets (1:1) in blocks of two and four patients. All patients and study personnel were masked to treatment assignment. Primary endpoints were the change in total NPI score and clinical global impression of change (CGIC) score after 26 weeks and were analysed by intention to treat. This study is registered with Clinicaltrials.gov, number NCT00545974.FindingsOf 100 patients screened, 81 were randomly assigned to receive memantine (39 patients) or placebo (42 patients). Five (6%) patients discontinued, and 76 completed the 26-week treatment. Enrolment numbers were lower than planned because of many patients' preference to take memantine or cholinesterase inhibitors off-label rather than participate in a clinical trial. Memantine treatment had no effect on either the NPI (mean difference 2·2, 95% CI -3·9 to 8·3, p=0·47) or CGIC (mean difference 0·0, -0·4 to 0·4, p=0·90) after 26 weeks of treatment. Memantine was generally well tolerated; however, patients in the memantine group had more frequent cognitive adverse events (six patients) than those in the placebo group (one).InterpretationMemantine treatment showed no benefit in patients with FTD. These data do not support memantine use in FTD.FundingForest Research Institute.Copyright © 2013 Elsevier Ltd. All rights reserved.

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