Objective: To examine the efficacy of memantine (20 mg), a non-competitive NMDAR antagonist, in the treatment of gait impairment in PD patients with mild cognitive impairment and dementia.

Background: Gait disorders and falls are very prevalent in Parkinson’s disease (PD), they are much difficult to manage. Recent evidence has indicated that gait impairment in PD is caused by multisystem lesion and non-dopaminergic dependent mechanisms play the leading role.

Method: This was a single-center, 14-week, prospective, randomized, no treatment control with blind assessment study design. A total 55 PD patients (mean age 74,6 years; mean duration of disease 7,5 years; median Hoehn and Yahr stage was 2,5) with Mini-Mental State Examination (MMSE) scores from 16 to 24 were randomly assigned to combination memantine and antiparkinsonian therapy (memantine group – 30 PD patients) and antiparkinsonian therapy alone (control group – 25 PD patients). Control group matched for age, sex, and stage and type of cognitive impairment nested in a cohort study. 3D analysis was carried out using the «DIERS pedogait» system during normal walking. Among the spatiotemporal gait parameters were evaluated step length, step time, cadence, foot rotation, load response phase, single support phase, pre-swing phase, swing-phase. Postural stability was measured by calculating the Centre of Pressure (CoP) deviation on force plate analysis.

Results: Memantine was well tolerated, without any serious adverse events, or worsening in the parkinsonian motor score. After 14 weeks there was a significant difference in MMSE score of memantine group before and after treatment (p<0.05). The spatiotemporal gait parameters (cadence and terminal stance) after 14 weeks were higher in memantine group than in control group. Participants in the memantine group after 14 weeks had a significant increase cadence (on 30%), marked differences were also found in the duration of pre-swing phase of gait, CoP deviation (p<0.05), while the stand and swing phases were not significantly different.

Conclusion: Apparently, the use of memantine is a promising direction of correction of disturbances of gait in PD by improving the glutamatergic transition from the striatum to specific areas of the cerebral cortex involved in the control of gait, and a larger placebo-controlled clinical study is warranted.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/memantine-and-3d-gait-analysis-in-patient-with-parkinsons-disease-an-observer-blind-randomized-clinical-trial/