"The results of this study should change the way we treat patients with Alzheimer's disease. Cholinesterase inhibitors are approved for use in mild to moderate dementia, while memantine has been approved for advanced dementia. But it looks like there is an advantage in prescribing both drugs (Aricept and Namenda) as initial treatment."--John Growdon, MD
Our doctor was familiar with the research, and he agree to put my mother on Namenda in a combination with Aricept.
It is my belief that the combination of Aricept and Namenda helped slow the progression of Alzheimer's in my mother. We were fortunate, and my mother did not suffer any side effects as the result of the addition of Namenda in her drug regimen.
If you try this combination therapy you have to be patient and wait about 4-6 weeks before decided whether or not you are seeing the benefits.
Information extracted from the journal article, my notes, and various outside sources.
"Finding something that could actually modify the course of the disease is the Holy Grail of Alzheimer's treatment, but we really don't know if that is happening or what the mechanism behind these effects might be," Alireza Atri explained.
"What we can say now is that providers should help patients understand that the benefits of these drugs are long term and may not be apparent in the first months of treatment. Even if a patient's symptoms get worse, that doesn't mean the drug isn't working, since the decline probably would have been much greater without therapy."
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Researchers at the Massachusetts General Hospital Memory Disorders Unit report in the journal Alzheimer Disease and Associated Disorders that combining two types of Alzheimer's drugs works better than giving none or one of the drugs alone to slow cognitive and functional decline.
The study found that people who took the combination of cholinesterase inhibitors (Aricept, Razadyne, or Exelon) and Memantine, showed a significantly slower rate of cognitve decline than those who took only a cholinesterase inhibitor or no drug.
Those in earlier stages of Alzheimer's disease are typically treated with cholinesterase inhibitors like Aricept, Razadyne, or Exelon.
Those suffering from later stage Alzheimer's disease are usually treated with Namenda (Memantine).
Led by Dr. Alireza Atri, the researchers analyzed the records of 382 patients who were treated at the Boston clinic from 1990 to 2005.
The earliest group of 144 patients did not receive any medication, the second group got a cholinesterase inhibitor approved by the Food and Drug Administration in the mid-1990s, and the third group took that drug plus memantine, a drug approved in 2003 that helps patients think more clearly.
The patients were followed for an average of two and a half years, and given tests to measure both their cognitive abilities and their capacity to carry out the activities of daily living.
People who took the combination of drugs showed a significantly smaller rate of decline than those who were taking only a cholinesterase inhibitor or no drug.
Memantine was not studied alone because by the time it was available, cholinesterase inhibitors were widely used. The researchers accounted for differences among the groups, such as how early in the disease they were diagnosed and whether they had other illnesses, but the differences in how they scored on tests of cognition and function still held true.
Previous clinical trials have compared the drugs with placebos in short studies of safety and effectiveness, but the MGH group says theirs is the first to look longer-term at patients in a real-world clinical setting. Their study was funded by the National Institute on Aging and theMassachusetts Alzehimer's Disease Research Center.
Note to readers and subscribers: The primary purpose of this article is to inform you of our experience, and decision concerning the treatment of my mother's Alzheimer's. I am not advocating any specific treatment here. Any treatments, or decisions on treatments, should be made in consultation with a qualified doctor and neurologist.
By the Alzheimer's Reading Room