Memantine and Intensive Speech-Language Therapy in Aphasia
A 24-Week Pilot, Double-Blind, Randomized, Parallel, Placebo-Controlled Study of Memantine and Constraint-Induced Language Therapy in Chronic Poststroke Aphasia:Correlation With Cognitive Evoked Potentials During Recovery.
- Aphasia, the loss or impairment of language caused by brain damage, is one of the most
devastating cognitive impairments of stroke. Aphasia can be treated with combination of
speech-language therapy and drugs. Conventional speech-language therapy in chronic
aphasic subjects is of little help and several drugs have been studied with limited
success. Therefore other therapeutic strategies are warranted.
- Recent data suggest that drugs (memantine) acting on the brain chemical glutamate may
help the recovery of cognitive deficits, included language, in subjects with vascular
dementia. The present study examines the safety profile and efficacy of memantine
paired with intensive language therapy in subjects with stroke-related chronic aphasia
(more than 1 yr. of evolution).
- The efficacy of drugs that act on glutamate such as the N-methyl-D-aspartic acid (NMDA)
receptor antagonist memantine requires to be explored in this population. The rationale
for using memantine in post-stroke aphasia comes from recent studies on vascular
dementia. Data extracted from a recent Cochrane review of randomized controlled trials
of memantine in different types of dementia (vascular dementia, Alzheimer's disease,
mixed dementia) reveal, after 6 weeks of treatment, beneficial effects on cognition
(including language), activities of daily living, behavior and global scales as well as
in the global impression of change.
- Recovery from aphasia is possible even in severe cases. While speech-language therapy
remains as the mainstay treatment of aphasia, its effectiveness has not been
conclusively proved. This has motivated the planning of more rational therapies (e.g.,
constraint-induced language therapy [Pulvermüller et al., 2001; 32: 1621-1626]).
- In addition, the neural correlates of improvement of language function can now be
readily detectable with event-related potentials. This is a noninvasive technique that
can detect in real time functional brain changes during recovery promoted by the
combined action of memantine and constraint-induced language therapy.
- The aim of the present study is to assess the efficacy, safety profile, and functional
correlates of memantine paired with massed language therapy in a sample of patients
with chronic poststroke aphasia.
Aphasia, Memantine, Constraint-induced language therapy, Event-related potentials
Gabinete Berthier y Martínez
Gabinete Berthier y Martínez, H. Lundbeck A/S
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