How long can Alzheimer's patients benefit from taking Aricept and Namenda?

To get control of my mother's wild violent combative outbursts and get her hallucinations under control, she is on an antipsychotic which is wonderful. She sleeps more but is happier when she's awake. We got around medication refusal by crushing it up and mixing it into vanilla ice cream then covering with chocolate sauce. She gets her sundaes twice a day and loves them!

Just saw my husband's neurologist yesterday. No drugs, no way, just bad side effects, and they will not prevent the disease from progressing. Heck, at 97 yrs. your mother is bound and determined to reach 100! My best to you both.

Good morning, like doctors, pharmacists have their own opinions regarding medication performance. Speak with a few of them to gain other perspectives.

Depending on which drug they are taking, patients are usually prescribed between 3mg-20mg each day. The cost of a generic version of Namenda (20mg/day) is typically a little more than of the generic version of Aricept (10mg/day), and seems to be less effective for most patients. The generic versions of Razadyne and Exelon are usually more expensive, but this varies depending on insurance coverage and where the drugs are purchased. Aricept, Razadyne, and Exelon work in the same way in the brain, while Namenda works through a different system. That is why doctors sometimes hope that adding Namenda to Aricept or the other drugs might have an added benefit for patients with moderate or severe dementia.

There is no cure for most types of dementia and treatments are not very effective. Current drugs merely delay decline and help reduce symptoms. Patients with mild Alzheimer’s disease won’t benefit from Namenda but will cost them money and could cause side effects. Some side effects of Namenda are dizziness, confusion, headache, sleepiness, constipation, vomiting, pain (especially in the back), and coughing. More serious side effects are rare but include shortness of breath and hallucination.2

A study by Lon Schneider and his colleagues from the University of Southern California Keck School of Medicine examined available evidence on the effectiveness of Namenda in patients with mild Alzheimer’s disease. 3 The researchers conducted a meta-analysis, meaning they pooled and analyzed data available from several different clinical trials, in order to evaluate a larger number of people. They analyzed data from three clinical trials that included 431 patients with mild Alzheimer’s disease and 697 patients with moderate Alzheimer’s.

All three clinical trials randomly assigned patients to either receive Namenda or a placebo, and neither patients nor investigators were aware of who was receiving the drug and who was not.3 This is called a “double-blind” study and it prevents bias based on expectations that a drug will improve the outcome being measured. In this case, investigators measured patient’s cognitive functioning, behavior, and ability to perform activities of daily living. They also measured “impression of change” in the patient according to the patient’s clinician and caregiver. Four different scales were used to measure these outcomes and then scores were compared between the Namenda and placebo groups.

The study concluded that Namenda was not effective in patients with mild dementia.3 This was true when they looked at each trial separately and also when they pooled data from the three studies and analyzed that.

Among patients with moderate Alzheimer’s disease, the effect of Namenda was very small.3 Looking at the trials separately, only one of the three trials found any statistically significant improvement for patients taking Namenda compared to patients taking placebo. Even that improvement was for only one measure – a subjective measure of the doctor or caregiver’s impressions of the patients’ behavior. When the data were combined, there was a statistically significant effect on cognitive functioning and impression of change. However, these differences were small—about half the impact of drugs like Aricept, Exelon, or Razadyne, which are commonly prescribed to treat Alzheimer’s symptoms.

A 2014 study found that male military veterans with mild or moderate dementia did not benefit from Namenda, whether taken alone or together with vitamin E.7 However, vitamin E taken alone did slow the progression of mild to moderate Alzheimer’s. Several other studies have also suggested that vitamin E can provide a moderate benefit for Alzheimer’s patients.4 However, high levels of vitamin E may be dangerous, sometimes increasing the chances of heart failure and death.5 For more information on vitamin E, please visit here.

More recent meta-analyses have evaluated Namenda for dementia ranging from mild to severe, based on randomized controlled trials. These have found a significant benefit of Namenda compared to placebo for patients with dementia ranging from moderate to severe for cognitive function, behavioral disturbances, and ability to function in activities related to daily life dementia, but not for patients with milder dementia.6 7 8

None of the current treatments for dementia will radically improve patients’ memory or thinking, nor will they stop the progression of the disease. However, Namenda may help moderate or severe dementia, while Aricept, Razadyne, or Exelon may help patients with dementia ranging from mild to severe.

This article was updated in 2016.

Forest Receives Non-Approvable Letter for Expanded Namenda Indication. Drug Industry Daily, Vol. 4 No. 145. July 26, 2005. ▲
National Library of Medicine. Medline Plus. Mema

Namenda and Seroquel have helped my mother tremendously. She was staying awake for 39 hours at a time, all the while keeping us awake too. Her pulse rate at times was 146. She also has Narcissistic Personality Disorder. She caused all of us to be at each other's throats. She would sit there and smirk while the chaos ensued. She treated me like her personal slave. She implied that we were stupid. Every day. My husband and I had to see cardiologists because we began having heart problems. We were perfectly fine until she moved in with us. She was brutal. Her doctor said to put her in a nursing home. I had promised her that I never would. However, she was tearing my family apart psychologically and damaging our health. Namenda and Seroquel were the last resort. We were DONE. After six weeks on the medicine she became a much nicer person. She goes to bed on time and sleeps. We are not walking zombies anymore. The constant trouble making and arguing is gone. Along with her Alzheimer's medicine, she is taking diazepam 2mg and melatonin at night. You must do what you feel is right for your loved one. All I know is, we have a drastic change for the better.

Exelon is FDA approved for Parkinson's dementia hence the dramatic improvement. Other antipsychotics are extremely dangerous for use with the elderly and may result in stroke and death.

I found this reference and hope it is helpful.
Dementia and behavioral disorders
In the case of elderly patients affected with dementia, every antipsychotic treatment must be prescribed at the lowest effective dosage and for the shortest period possible. The severity and frequency of symptoms and the global functioning and quality of life, as reported by caregivers, must be always monitored during treatment.17,18,48

Based on the results of the Clinical Antipsychotic Trials of Intervention Effectiveness – Alzheimer’s Disease (CATIE-AD), the role of atypical antipsychotics in influencing cognitive performance in patients with Alzheimer’s is still debated. Some trials show that risperidone reduces the Mini-Mental State Examination scores in a statistically significant way compared with placebo, which is not the case with olanzapine and quetiapine. On the contrary, other trials indicate that quetiapine and olanzapine are responsible for greater cognitive decline. The samples of individual clinical trials are not enough to determine whether the cognitive decline varies with antipsychotic use; however, this decline has been evident for all the molecules compared to placebo.34

Risperidone has been found to be very effective in the treatment of some behavioral disorders such as agitation, aggression, and wandering in patients with dementia (off-label use).10,17,29,49–51 Behavioral and psychological symptoms of dementia may be both the consequence of cognitive impairment and bipolar disorder comorbidity that of an existing bipolar diathesis, which change the clinical expression of dementia.52 Agitation often worsens some types of dementia and atypical antipsychotics are often effective, even if their use is off-label. A review performed in 2012 comparing the efficacy of off-label use of atypical antipsychotics in dementia suggested that olanzapine, aripiprazole, and risperidone have a moderate-to-high efficacy in agitation.53 Furthermore, risperidone is indicated in dementia and secondary psychoses.

Although the use of antipsychotics for dementia is off-label, antipsychotics are probably the best option for short-term treatment (6–12 weeks) of severe, persistent, and resistant aggression.54 Serious adverse events are a major contraindication to long-term therapy, thus suggesting that dosage be decreased and treatment interrupted whenever sufficient control of behavioral symptoms has been obtained.

Acute onset of confusion and delusions often occur in elderly hospitalized patients and may be effectively treated with second-generation antipsychotics. On the contrary, haloperidol has long been considered the drug of choice for treating agitation and aggression. At present, olanzapine, quetiapine, and risperidone show the same efficacy profile in acute stages of disease, without inducing the neurological effects of haloperidol. Ziprasidone and aripiprazole require careful use in acute stages since they are associated with a higher risk of arrhythmias.

My mom has advanced dementia (85). She's been on exelon patch 3 years (skipping it makes a huge difference). She's been on seroquel at night starting at 25 mg for a couple of year, then 50 mg for a year, and now 100 mg at night. Seroquel at night makes a huge difference. If she gets overly stressed or agitated, we give her 25 mg of seroquel and she calms down, has a little nap, and feels allot better. A year ago we added namenda. I can't tell any difference but both primary doctor and neurologist think it works well with the other drugs that think it's important to continue. I'm continuing only because they both keep current with all studies and I trust their opinion.

My mother (age 90) was taken off Namenda last winter after about six years. She is still on Donepezil. Seroquel was added at about the same time to control agitation and aggression. Neither her caregivers or I have noticed any significant change in cognitive function since the Namenda was discontinued. The Seroquel has helped to calm her (most of the time), and the dosage has gone from 25mg per day to a total of 75 mg per day in three doses. At this point, my goal is to keep her calm and relatively happy and not worry so much about cognitive decline because there is not much left to lose.

Go to Namenda's site

All of this information is very helpful. Still, I feel as if I'm not sure which way to go. Are these typical Alzheimers meds ever prescribed for someone with Vascular Dementia?

I'm consulting with a Geriatric Psychiatrist in a couple of weeks with my cousin, who has severe dementia. She's done quite well with her anxiety on Cymbalta and small dose of Seroquel at night, but lately is overly worried about where her long deceased parents are. She looks for them a lot in her wheelchair and is distressed.

I wonder if the psychiatrist will prescribe Namenda. She has never taken it. She is receiving Palliative care and my goal is to keep her as comfortable and content as possible. Quality, not quantity. If a med will help her distress, I'm for it, but, I guess, I've just never heard many good things about it or Aricept. I'd rather limit her meds if possible.

Does the doctor lay out the options and then let you decide? I'm her Healthcare POA. Will he give me the chance to think it over? I just don't want to be pressured into a med that could have bad side effects, that could then make her decline more.

There are television ads for these 2 meds every day. Watch them.