Alzheimer’s dementia (AD) is a very unpleasant chronic medical disorder that brings a lot of anguish to everyone looking after the involved patient. There are no good methods to make an early diagnosis and to make matters worse, there is no good medical treatment.
The acetylcholine-esterase inhibitor, such as Aricept, has not proven to be effective in clinical trials. (Cochrane reviews) In the last decade, several novel drugs have been developed to treat AD, of which one of them is memantine (Namenda). Unlike Aricept, Namenda works on a different chemical in the brain.
The company that manufactures memantine has heavily promoted the drug. The majority of medical journals and online medical WebPages contain ads about memantine.
Today many physicians prescribe memantine for mild dementia; however, its efficacy has only been shown in trials supported by the manufacturer.
In the latest study, done by Schneider and colleagues at the University of Southern California, they systematically analyzed all the data on memantine and extracted pertinent data, which were in turn analyzed by independent reviewers. (1) The researchers found that for patients with mild dementia or cognitive impairment, memantine had no more benefit than a placebo. Only a few individuals with moderate dementia had a mild benefit from the drug.
The researchers concluded that based on current clinical data, memantine is not a drug of choice for mild dementia. Moreover, the drugs benefits for moderate dementia are very mild. Thus, the researchers have urged the U.S. Food and Drug Administration to not extend the indication of memantine for mild dementia.
Another important factor that has substantial importance in today's economy is the price of memantine. Depending on where you buy the drug, each pill can cost anywhere from $2-$4. Memantine is supposed to be taken twice a day and this amounts to $120-$240 a month. (2)
Finally, there is no way of knowing if the drug will work. In the UK, the National Institute for Clinical Excellence recently opposed the use of memantine because they felt the costs and its side effects clearly outweighed any possible benefit. Current work is being undertaken to determine if memantine can be safely combined with other similar drugs for more effectiveness. For the moment, the treatment of patients with AD is empirical. Treatment is based on symptoms and tolerability of drugs like Aricept.
Sources:
1. Lack of Evidence for the Efficacy of Memantine in Mild Alzheimer Disease at
http://archneur.ama-assn.org/cgi/content/abstract/archneurol.2011.69v1
2. Memantine (Namenda) for Moderate to Severe Alzheimer’s Disease
Am Fam Physician. 2004 Mar 15;69(6):1491-1492).
http://www.aafp.org/afp/2004/0315/p1491.html
3. Evidence Lacking for Efficacy of Memantine in Treating Mild Alzheimer's Disease, Study Finds
http://www.sciencedaily.com/releases/2011/04/110411163809.htm
4. Memantine: a review of studies into its safety and efficacy in treating Alzheimer’s disease and other dementias
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762361/
5. National Institute for Clinical Excellence
http://www.nice.org.uk/guidance/index.jsp?action=byID&o=13419
6. Cochrane Review: Donepezil for mild cognitive impairment
www2.cochrane.org:reviews:en:ab006104.html
Reviewed June 7, 2011
Edited by Alison Stanton