Effect of Methylphenidate on Apathy in Patients With Alzheimer Disease : The ADMET 2 Randomized Clinical Trial

Importance: Apathy, characterized by diminished will or initiative and one of the most prevalent neuropsychiatric symptoms in individuals with Alzheimer disease, is associated with significant caregiver burden, excess disability, increased medical costs, and mortality.

Objective: To measure whether methylphenidate compared with placebo decreases the severity of apathy in individuals with Alzheimer disease.

Design, Setting, and participants: This multicenter randomized placebo-controlled clinical trial was conducted from August 2016 to July 2020 in 9 US clinics and 1 Canadian clinic specializing in dementia care. A total of 307 potential participants were screened. Of those, 52 did not pass screening and 55 were not eligible. Participants with Alzheimer disease, mild to moderate cognitive impairment, and frequent and/or severe apathy as measured by the Neuropsychiatric Inventory (NPI) were included.

Interventions: Ten milligrams of methylphenidate, twice daily, vs matching placebo.

Main Outcomes and Measures: The coprimary outcomes included (1) change from baseline to 6 months in the NPI apathy subscale or (2) improved rating on the Alzheimer's Disease Cooperative Study Clinical Global Impression of Change. Other outcomes include safety, change in cognition, and quality of life.

Results: Of 200 participants, 99 were assigned to methylphenidate and 101 to placebo. The median (interquartile range) age of study participants was 76 (71-81) years; 68 (34%) were female and 131 (66%) were male. A larger decrease was found from baseline to 6 months in the NPI apathy score in those receiving methylphenidate compared with placebo (mean difference, -1.25; 95% CI, -2.03 to -0.47; P = .002). The largest decrease in the NPI apathy score was observed in the first 100 days, with a significant hazard ratio for the proportion of participants with no apathy symptoms receiving methylphenidate compared with placebo (hazard ratio, 2.16; 95% CI, 1.19-3.91; P = .01). At 6 months, the odds ratio of having an improved rating on the Alzheimer's Disease Cooperative Study Clinical Global Impression of Change for methylphenidate compared with placebo was 1.90 (95% CI, 0.95-3.84; P = .07). The difference in mean change from baseline to 6 months estimated using a longitudinal model was 1.43 (95% CI, 1.00-2.04; P = .048). Cognitive measures and quality of life were not significantly different between groups. Of the 17 serious adverse events that occurred during the study, none were related to the study drug. No significant differences in the safety profile were noted between treatment groups.

Conclusions and Relevance: This study found methylphenidate to be a safe and efficacious medication to use in the treatment of apathy in Alzheimer disease.

Trial Registration: ClinicalTrials.gov Identifier: NCT02346201.

Errataetall:

CommentIn: JAMA Neurol. 2021 Nov 1;78(11):1311-1313. - PMID 34570178

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - volume:78

Enthalten in:

JAMA neurology - 78(2021), 11 vom: 01. Nov., Seite 1324-1332

Sprache:

Englisch

Beteiligte Personen:

Mintzer, Jacobo [VerfasserIn]
Lanctôt, Krista L [VerfasserIn]
Scherer, Roberta W [VerfasserIn]
Rosenberg, Paul B [VerfasserIn]
Herrmann, Nathan [VerfasserIn]
van Dyck, Christopher H [VerfasserIn]
Padala, Prasad R [VerfasserIn]
Brawman-Mintzer, Olga [VerfasserIn]
Porsteinsson, Anton P [VerfasserIn]
Lerner, Alan J [VerfasserIn]
Craft, Suzanne [VerfasserIn]
Levey, Allan I [VerfasserIn]
Burke, William [VerfasserIn]
Perin, Jamie [VerfasserIn]
Shade, David [VerfasserIn]
ADMET 2 Research Group [VerfasserIn]
Kominek, Victoria [Sonstige Person]
Michalak, Hannah [Sonstige Person]
Ni, Gessica [Sonstige Person]
Good, Susan [Sonstige Person]
Mecca, Adam [Sonstige Person]
Salem-Spencer, Susan [Sonstige Person]
Keltz, Melanie [Sonstige Person]
Morales, Esmeralda [Sonstige Person]
Clark, Emily D [Sonstige Person]
Williams, Arthur [Sonstige Person]
Kindy, Arianne [Sonstige Person]
Freeman, Richard [Sonstige Person]
Jamil, Nimra [Sonstige Person]
Schultz, Meghan [Sonstige Person]
Sami, Susie [Sonstige Person]
Padala, Kalpana P [Sonstige Person]
Parkes, Christopher [Sonstige Person]
Lah, James [Sonstige Person]
Vaughn, Phyllis [Sonstige Person]
Hales, Chad [Sonstige Person]
Rapoport, Mark [Sonstige Person]
Gallagher, Damien [Sonstige Person]
Li, Abby [Sonstige Person]
Sandra, Black [Sonstige Person]
Vieira, Danielle [Sonstige Person]
Ruthirakuhan, Myuri [Sonstige Person]
Babani, Prakash [Sonstige Person]

Links:

Volltext

Themen:

207ZZ9QZ49
Central Nervous System Stimulants
Journal Article
Methylphenidate
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Anmerkungen:

Date Completed 14.01.2022

Date Revised 21.02.2023

published: Print

ClinicalTrials.gov: NCT02346201

CommentIn: JAMA Neurol. 2021 Nov 1;78(11):1311-1313. - PMID 34570178

Citation Status MEDLINE

doi:

10.1001/jamaneurol.2021.3356

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM331118017