Memantine in the treatment of dementia: a nationwide real-world analysis

Despite the growing global burden of dementia, real-world data that adequately reflect the current state of healthcare systems, dementia care pathways, and the actual impact of pharmacological treatment practices remain limited, hindering the evidence-based planning and implementation of novel therapies. This retrospective cohort study evaluated nationwide anti-dementia drug treatment practices, particularly focusing on memantine use, and their effect on survival. Using the nationwide NEUROHUN database, data from 398,584 patients with dementia from 2010 to 2020 in Hungary were analyzed (mean age at diagnosis 75.22 years). Kaplan-Meier analyses and multivariable Cox proportional hazards models were conducted to evaluate survival outcomes, adjusting for age and sex. Annual prescription prevalence, medication adherence, and persistence metrics were also calculated. Only 13% of patients received any anti-dementia drug (donepezil, rivastigmine, or memantine); among those treated, 24% received memantine as monotherapy. Untreated patients had the shortest median survival (3.1 years), followed closely by those on memantine monotherapy alone (3.7 years). This pattern likely reflects the older age, delayed diagnosis, and presumably more advanced disease stage of these patients rather than a direct effect of memantine. Patients receiving memantine and donepezil showed the lowest mortality risk (HR = 0.581) compared to the untreated group. Symptomatic pharmacological treatments are likely to remain important adjuncts to emerging disease-modifying therapies, given their evidence-based benefits in dementia care. This is the first study in the Central-Eastern European region to evaluate memantine under real-world conditions, highlighting the high proportion of late diagnoses and underscoring the need to establish earlier and more efficient diagnostic pathways.