Johns Hopkins Health Alert
Does Namenda Work? Dr. Rabins Addresses a Difficult Question
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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