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Volume 349:609-610 August 7, 2003 Number 6
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Memantine in Moderate-to-Severe Alzheimer's Disease

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by Reisberg, B.
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To the Editor: Reisberg et al. (April 3 issue)1 observed that the N-methyl-D-aspartate (NMDA) antagonist memantine2 appears to be helpful in patients with moderate-to-severe Alzheimer's disease. There is evidence that an increased plasma homocysteine level is an independent risk factor for the development of Alzheimer's disease.3 Homocysteine acts as an agonist at the NMDA receptor, mediates excitotoxicity,4 and disturbs glutamatergic neurotransmission (with associated changes such as an impaired signal-to-noise ratio or long-term potentiation). Furthermore, elevated homocysteine levels are associated with decreased global cognitive performance in patients with Alzheimer's disease3 as well as nondemented elderly persons.5 Homocysteine may act as . . . [Full Text of this Article]



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