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Does Namenda Work? Dr. Rabins Addresses a Difficult Question

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In this excerpt from a recent issue of the Memory Disorders Bulletin, medical editor Dr. Peter V. Rabins confronts the difficult question: What do you do when a caregiver asks, "Dr. Rabins, do you think that Namenda is really working?"

Namenda (memantine) was widely available for about 20 years in Europe before it received approval in 2003 for Alzheimer’s disease therapy from the Food and Drug Administration (FDA). Namenda is approved for people with moderate and severe Alzheimer’s disease, but some doctors, including memory and dementia experts, offer it to all of their patients with Alzheimer's, regardless of the severity of their symptoms.

Many doctors who are specialists in Parkinson's disease and frontotemporal dementia are using Namenda for their patients with dementia symptoms, even though it is not FDA-approved for that. While it is perfectly within their purview to use a medication "off label" for Alzheimer’s disease if they feel it's warranted, I hope studies will be carried out to tell us whether Namenda does have positive benefits.

There is no cure for Alzheimer’s disease, so the goal of drug therapy for Alzheimer’s disease is to help manage the symptoms. Improvement in cognition is an indicator that Namenda might be working. Therefore, when a caregiver asks me if I think that Namenda is working or not for their loved one, I answer "yes" only when I can see an improvement on a scale that measures cognition or thinking.

Should you choose Namenda? The decision to use Namenda depends more on the preferences of the Alzheimer’s disease patient and his or her family than on the science. Many families and caregivers say, "If Namenda might help, even a little bit, I want my loved one to take it."

On the other hand, some families and patients say, "I don't want to take something that will only make a small difference." For these individuals, I work to get them as much information about Alzheimer’s disease as possible to help manage any behavioral or psychiatric symptoms and to address the financial, legal, ethical and social problems they are facing.

There is no "right" or "wrong" when it comes to this issue. It is the patient and family who should make the final decision, not the doctor. I feel the same way about stopping Namenda. It is up to the patient and family to decide once they are given the information in a balanced and fair manner.

However, colleagues whose opinions I value feel that a drug such as Namenda offers false hope and the benefit is so minimal that it should not be used unless family members feel strongly that they want to try it with their loved one.

Posted in Memory on November 7, 2011

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Author tends to ignore data reflected in this study:

A review of the effects of memantine on clinical progression in Alzheimer's disease; Wilkinson D; International Journal of Geriatric Psychiatry (Oct 2011)

BACKGROUND: As Alzheimer's disease (AD) progresses, patients become increasingly dependent on others, placing a substantial impact on the daily lives of patients and caregivers. A treatment that slows clinical progression is a realistic and meaningful therapeutic goal for patients and caregivers. If given early, such a treatment would be expected to maximise any potential benefit. Memantine has shown clinical benefits in the key domains of AD, both as monotherapy and in combination with a cholinesterase inhibitor (ChEI). METHODS: Memantine now has a considerable database of published studies and is associated with benefits in aspects of behaviour, cognition and communication, and on clinical progression. The results of these clinical studies are reviewed. RESULTS: Short-term clinical studies (≤28 weeks) have shown that memantine reduces clinical worsening and has also demonstrated positive effects in aspects of cognition-language, memory, praxis, functional communication-and in activities of daily living. Furthermore, memantine has been shown to reduce the rate of emergence of troublesome behaviour in patients with AD who were asymptomatic at baseline. Long-term follow-up studies (>1 year) have shown that the benefits of memantine are sustained and increase over time, and that memantine can delay nursing home placement in patients with AD. CONCLUSIONS: These findings provide evidence for the benefits of memantine, either alone or in combination with a ChEI, in slowing clinical progression in AD, and indicate that early treatment initiation may maximise clinical success. The benefits of memantine increase over time, allowing patients to remain independent for longer, alleviating caregiver burden and delaying institutionalisation

Posted by: starrin | November 7, 2011 7:05 AM

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