Your Loved One Has Alzheimer’s Disease – Now What?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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When your friend or family member is diagnosed with Alzheimer’s disease your second thought, after the despair sets in, will be to wonder what treatment options are available. The answer is that while there are options available for treatment, they just don’t work very well.

Here is what we know:

Aricept (donepezil) has been around the longest and is available in a tablet and an oral dissolvable tablet (ODT) for mild, moderate, or severe dementia. Donepezil attempts to help Alzheimer patients by increasing the amount of acetylcholine floating around at the receptor. Donepezil is generally well tolerated but has well-described side effects of nausea, diarrhea, and insomnia, among others.

Namenda (memantine) then came along for the treatment of Alzheimer’s disease. Namenda is available both as an immediate release and extended release tablet (Namenda XR) and it’s expensive. Side effects include dizziness, confusion, headache, hallucinations, and diarrhea, and I’ve seen all of those in my patients.

Before you spend the money or risk the side effects of these dementia medications, how well do they work?

A recent study looked at the treatment of moderate to severe Alzheimer disease and asked that same question: which medications work, is there a noticeable difference, and is one better than two together?

Patients already taking donepezil (Aricept) were divided in to four groups:

1. No therapy (donepezil was discontinued)

2. Donepezil alone

3. Donepezil (Aricept) plus memantine (Namenda)

4. Namenda alone

After one year, average scores on two dementia assessments (the Mini Mental Status Examination and the Bristol Activities of Daily Living) showed slight benefit for patients receiving donepezil or memantine therapy compared to those not receiving treatment. Ok, so that sounds promising. Well, not really. In general, the differences in scores did not meet the thresholds considered to be clinically important. What this means is that you wouldn’t notice a difference in your loved one on or off medications. What about both medications together? No benefits were noted for the combination of memantine and donepezil over donepezil alone.

I know this sounds discouraging, and it is. When there are no other options it is worth taking a leap of faith, but watch closely to make sure the downsides (cost, side effects) don’t outweigh the upsides for your loved one.

Thoughts?

Dr. O.

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