Apr 23, 2010

Can the Combination of Aricept and Namenda Keep You Out of a Nursing Home

This observational study revealed that the addition of Namenda (Memantine) to the treatment of Alzheimer's disease with cholinesterase inhibitors (like Aricept) significantly altered the treated history of Alzheimer's patients by extending time to nursing home admission.

By Bob DeMarco
+Alzheimer's Reading Room

Can the Combination of Aricept and Namenda Keep You Out of a Nursing Home

One of the goals of most Alzheimer's caregivers is to keep their loved one out of a nursing home as long as possible.

Since that is a shared goal of mine, this research caught my attention.

"The combination of the current symptomatic treatments for Alzheimer's disease improved the patients' quality of life, since those who used concomitantly cholinesterase inhibitors -- donepezil, galantamine, or rivastigmine -- and memantine had a diminished risk of institutionalization compared to those who used no medication or used cholinesterase inhibitors alone." -- Dr. O. L. Lopez, University of Pittsburgh School of Medicine
Let me simplify this. This study revealed that Namenda in combination with a cholinesterase inhibitor, like Aricept, altered the treated history of Alzheimer's patients by extending time to when they might be admitted to a nursing home.

Bottom line, the combination of Namenda (Memantine) and Aricept might keep your loved one out of a nursing home longer.

The same research also revealed that of the 934 patients studied:
  • 14.9% used the combination of Namenda and a cholinesterase inhibitors,
  • 45.0% used cholinesterase inhibitors alone (Aricept, Exellon, Razadyne),
  • and 40.1% used neither.
This left me wondering. Are these statistics close to the national statistics. My guess is that they are.

So, only 14.9 percent of Alzheimer's patients are on a combination treatment. This saddens me.

Related Content

I've written repeatedly about my belief that the combination of Aricept (or comparable drug) and Namenda should be prescribed as soon as Alzheimer's is diagnosed. We have several readers that were put on the combination of the drugs and are doing extremely well. For example, one of our readers sent me this in an email (snippet).
I'm a lucky one, in that my physician put me on both drugs upon diagnosis of "early Alzheimer's" nearly five years ago, and I'm still functioning, driving, making music, and generally enjoying life. I'm still in "mild cognitive impairment" six years after losing my ability to work due to the disease.
See these article for more information.
I also find it very discouraging that 40.1 percent of the patients diagnosed with probably Alzheimer's disease in this study weren't receiving any medication for Alzheimer's. Forty percent. I'd like to see a study on how they do over time.

Here is an abstract of the research paper if you want the meat and potatoes.

Abstract

Background: Patients using cholinesterase inhibitors (ChEIs) have a delay in nursing home (NH) admission compared with those who were not using the medication. There are no long-term studies of the effects of memantine in combination with ChEIs use in Alzheimer disease (AD). This study was conducted to examine the effects of ChEIs and memantine on time to death and time to NH admission.

Methods: Time to NH admission and death was examined in 943 probable AD patients who had at least a 1-year follow-up evaluation. Of these patients, 140 (14.9%) used both ChEIs and memantine, 387 (45.0%) used only ChEIs, and 416 (40.1%) used neither. The mean (SD) follow-up time was 62.3 (35.8) months. The analysis was conducted with multivariable Cox proportional hazard models controlling for critical covariates (ie, age, education level, gender, severity of the dementia, hypertension, diabetes mellitus, heart disease, psychiatric symptoms and use of psychotropic medications).

Results: Compared with those who never used cognitive enhancers, patients who used ChEIs had a significant delay in NH admission (HR: 0.37, 95% CI 0.27 to 0.49); this effect was significantly augmented with the addition of memantine (HR: 0.29, 95% CI 0.11 to 0.72) (memantine+ChEI vs ChEI alone). ChEIs alone, or in combination with memantine had no significant association on time to death.

Conclusions: This observational study revealed that the addition of the NMDA receptor antagonist memantine to the treatment of AD with ChEI significantly altered the treated history of AD by extending time to nursing home admission.

Source: Long-term effects of the concomitant use of memantine with cholinesterase inhibition in Alzheimer disease

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