Memantine in Korean Alzheimer’s disease: A prospective real-world REMIND study

Objectives Prospective real-world evidence on memantine in Korean patients with Alzheimer's disease remains limited. This study evaluated its real-world effectiveness and tolerability over 24 weeks of routine clinical practice. Design & setting Multicenter, prospective, single-arm observational study conducted at twelve university-affiliated tertiary hospitals in Korea. Participants Patients aged ≥ 50 years with Alzheimer's disease (Mini-Mental State Examination score of 5–20 and either a Clinical Dementia Rating of 2–3 or a Global Deterioration Scale score of 4–7) initiated on memantine (Ebixa®) 10–20 mg/day. The safety set comprised 401 patients and the effectiveness set 339. Measurements The primary outcome was change in the Clinical Dementia Rating global score at Week 24. Secondary outcomes were changes in the Clinical Dementia Rating Sum of Boxes, Mini-Mental State Examination, Neuropsychiatric Inventory, and Zarit Burden Interview at Weeks 12 and 24, together with treatment persistence and adverse events. Results At Week 24, 86.6% of 339 effectiveness-set patients remained within their baseline Clinical Dementia Rating category, 10.5% worsened, and 2.9% improved. Mini-Mental State Examination scores increased and Neuropsychiatric Inventory total scores decreased at both visits (all p < 0.05), with small standardized effect sizes (absolute d 0.08–0.17). Zarit Burden Interview scores increased at both visits. Treatment persistence was 89.5% at Week 24, and drug-related adverse events occurred in 17.7%. Conclusion Over 24 weeks of memantine treatment, most patients remained within their baseline Clinical Dementia Rating category, cognitive and neuropsychiatric scores showed small within-patient changes, caregiver burden increased, and tolerability was acceptable.