The use of combination therapy for Alzheimer's disease patients improves the quality of life, since those who use cholinesterase inhibitors (donepezil, galantamine, or rivastigmine) and memantine in combination had a diminished risk of institutionalization compared to those who used no medication or used cholinesterase inhibitors alone....
By Carole B. Larkin and Bob DeMarco
Alzheimer's Reading Room
Dr. Kevin O'Neil's comment: Memantine is indicated for the treatment of moderate to severe Alzheimer’s disease. Several clinical studies have demonstrated in such persons a favorable effect on cognition, behaviors such as agitation and aggression, and activities of daily living. However, we can expect that nonmedical reasons for discontinuing medications in nursing home residents will escalate as budgetary concerns and perceived lack of benefit surface. This study showed that sudden withdrawal of Memantine in persons with moderate to advanced Alzheimer’s disease resulted in a decline in overall health status within 2-3 months, compared with continued Memantine treatment.
- OBJECTIVE: To estimate the effect of memantine (Namenda®) discontinuation for a nonmedical reason (e.g., formulary restriction or family decision) on the health status of nursing home (NH) residents with Alzheimer's disease (AD).
- DESIGN: Retrospective chart review.
- RESULTS: Compared with continuous treatment, memantine discontinuation was associated with a significant increase in the Total AD Symptom Change Score (i.e., worsening) in all comparison pairs. The symptoms showing greatest worsening aggregated into two factors: cognition and mood.
- CONCLUSIONS: Memantine discontinuation in NH residents with AD may be associated with declining health status, and should be considered with care. A randomized, placebo-controlled trial of treatment discontinuation is merited.
***Dr. Kevin O'Neil is the medical director for Brookdale Senior Living the largest chain of senior living communities in the United States.
Can the Combination of Aricept and Namenda Keep You Out of a Nursing Home
"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
- Background: Patients using cholinesterase inhibitors (ChEIs) have a delay in nursing home (NH) admission compared with those who were not using the medication. This study was conducted to examine the effects of ChEIs and memantine on time to death and time to nursing home admission.
- Methods: Time to nursing home admission and death was examined in 943 probable Alzheimer's disease 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 (Namenda) to the treatment of Alzheimer's disease with ChEI significantly altered the treated history of Alzheimer's disease by extending time to nursing home admission.
Source: Long-term effects of the concomitant use of memantine with cholinesterase inhibition in Alzheimer disease
Carole Larkin MAG, CMC, CAEd ,QDCS, EICS, is a Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementias issues. She also trains caregivers in home care companies, assisted livings, memory care communities, and nursing homes in dementia specific techniques for best care of dementia sufferers. ThirdAge Services LLC, is located in Dallas, TX.
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Bob DeMarco is the Founder of the Alzheimer's Reading Room and an Alzheimer's caregiver. Bob has written more than 2,101 articles with more than 272,100 links on the Internet. Bob resides in Delray Beach, FL.
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Original content Carole Larkin and Bob DeMarco, the Alzheimer's Reading Room