What clinical trial evidence exists for Neurocept's efficacy on cognition versus memantine?

1. What the record actually contains: no trial data for “Neurocept”

None of the supplied documents mention “Neurocept,” its mechanism, or any clinical trials of a drug by that name; therefore claims about Neurocept’s efficacy versus memantine are not supported by the current set of sources — “available sources do not mention Neurocept” ^{[4] [3] [1]}.

2. What memantine’s trial evidence shows on cognition (summary of randomized data)

Randomized, placebo‑controlled trials and pooled analyses in moderate‑to‑severe Alzheimer’s disease report that memantine produced statistically significant improvements on cognitive scales (for example ADAS‑cog, MMSE, or SIB) and on some global/behavioral measures compared with placebo; systematic reviews and pooled analyses conclude memantine shows benefit with generally mild adverse effects ^{[2] [1] [3]}.

3. Trials that directly compare memantine and donepezil, or combine them

The DOMINO‑AD trial (a pragmatic, multicenter, double‑blind, 52‑week RCT) investigated continuation versus discontinuation of donepezil and the addition of memantine in patients progressing to moderate‑severe disease; its results indicated continuing donepezil gave cognitive and functional benefits over 12 months, while combination benefits relative to donepezil alone were not clearly superior in that trial ^{[4] [5]}. Earlier RCTs tested memantine added to donepezil and found mixed evidence; some pooled analyses and later meta‑analyses report that combination therapy may show advantages on some measures (not uniformly across all cognitive tests) particularly in more severely impaired subgroups ^{[6] [7] [1]}.

4. How systematic reviews and meta‑analyses interpret the evidence

A 2018 meta‑analysis of 18 randomized trials looked at memantine’s risk–benefit profile across thousands of patients and identified variability across studies, which complicates simple conclusions about magnitude of effect; other recent meta‑analyses focusing on combining donepezil and memantine note possible benefit on certain scales (for severe impairment on the SIB) but heterogeneity and differing outcomes (e.g., MMSE) limit definitive statements ^{[3] [7]}.

5. Clinical significance versus statistical significance — the debate in sources

The DOMINO investigators and subsequent commentaries highlighted that some statistically significant differences (e.g., on cognitive scores) may be small and that the clinical meaningfulness of those changes has been debated; nevertheless, guideline bodies have continued to endorse cholinesterase inhibitors and memantine for moderate‑to‑severe disease based on the totality of evidence ^{[4] [5]}.

6. Safety and tolerability context from the literature

Reviews and pooled analyses report memantine’s adverse‑event profile as generally mild and acceptable in trials, with specific rates of some events (e.g., seizures reported in some datasets) discussed in regulatory and formulary materials; safety was part of the larger assessment in trials that established memantine’s license for moderate‑to‑severe AD ^{[2] [8]}.

7. Real‑world/observational and survival signals — complementary data

A recent observational causal‑inference study reported an association between combined donepezil and memantine use and increased five‑year survival in electronic health record data; this is a nonrandomized analysis and does not replace randomized trial evidence comparing cognitive efficacy head‑to‑head, but it adds a population‑level outcome to consider ^[9].

8. Bottom line for your comparison question

Given the provided sources: memantine (alone or with donepezil) has randomized trial evidence showing modest cognitive and functional benefits in moderate‑to‑severe Alzheimer’s disease ^{[2] [1]}. There is direct randomized evidence addressing memantine added to or compared with donepezil in transition to moderate‑severe disease (DOMINO‑AD and related RCTs), but results vary by outcome measure and subgroup and combination therapy advantages are not uniformly replicated ^{[4] [5] [6]}. No supplied source provides any clinical‑trial data for a drug called “Neurocept,” so comparative efficacy claims involving Neurocept cannot be evaluated from the current reporting (available sources do not mention Neurocept) ^{[4] [3]}.

If you want, I can (a) extract key numerical effect sizes and confidence intervals from any of the memantine RCTs or meta‑analyses cited here (identify which paper), or (b) search for any mention of “Neurocept” in newer literature — but that would require additional sources beyond the ones you supplied.