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Medical Forum / Diseases and Disorders / Alzheimer's / November 2004Aricept and Namenda
Hi Folks, I just found this list while doing a search on Aricept+Namenda. My Mum is 93 yr old and failing healthwise, energy-wise, some short term memory loss, etc. She had a TIA in Jan and then a relatively mild stroke in May about 4 yrs ago and then one drug after another has been added. As far as I know, we do not have any official diagnosis such as Alzheimers; in fact two Neurologists in her home town said she definitely didn't have Alz. About 15 mos ago she moved to another state to an Assisted Living residence which is about 15 min from one of my sis'. Possibly due to stress of that move, her Mac Degen went in to overdrive and she has minimal eyesight. She has not acclimated to being near blind and I think it had tremendously affected her willingess to interact with other residents. Reading thru some of the posts, I do think she is bored silly and that is exacerbating any symptom she might experience. Since the move she has been with a managed health care of which I have minimal regard. They put her on Aricept a while back at 10 mg dose; she seems to experience increased dizziness, fogginess and they discontinued. Someone help me out here - the little I've read of Aricept is that it MIGHT be useful in Alz but it is not helpful in age-related decrease in eg short-term memory. About 2 wks ago they put her on Namenda; and are now considering the Namenda-Aricept combo. Is Namenda useful for folks with some short-term memory loss who do not have Alz. Also, without doing a premature postmortem on Mom's brain, how is Alz diagnosed??? That's a lot to ask, but any comments would be most appreciated! Basirah >Since the move she has been with a managed health care of which I have >minimal regard. They put her on Aricept a while back at 10 mg dose; she >seems to experience increased dizziness, fogginess and they discontinued. Many of these side-effects are transient (~2 weeks) but if two neurolgists have ruled out AD and she has other organic causes (i.e., the TIA), then perhaps she doesn't need a boost in this department. >Someone help me out here - the little I've read of Aricept is that it >MIGHT be useful in Alz but it is not helpful in age-related decrease in eg >short-term memory. About 2 wks ago they put her on Namenda; and are now >considering the Namenda-Aricept combo. Is Namenda useful for folks with >some short-term memory loss who do not have Alz. To my knowledge, the combination has not been tested in patients that do not suffer from AD. If she didn't tolerate the Aricept previously and it was given for longer than 2 weeks, I'd expect a return and perhaps worsening of the symptoms. What was their rationale for prescribing Namenda? >Also, without doing a premature postmortem on Mom's brain, how is Alz >diagnosed??? It's a diagnosis based on exclusion of other causes although recently, PET scans have proved somewhat useful (can anyone share an experience here?). They will also perform mini-mental state exams and clock- drawing tests, amongst others. Darryl. Darryl and all, Thanks very much for your comments, I'd be very interested in anyone's experience w/ PET. This is my first reply, so I'm not sure if Darryl's response will also show up, forgive me if I repeat! 1) "Many of these side-effects are transient (~2 weeks) but if two neurolgists have ruled out AD ...." Mom was on the Aricept for more than 2 wks, several months I think. I didn't notice that it did her any good, if anything she has an increase in issues such as dizziness, etc. 2) "What was their rationale for prescribing Namenda?" Beats me. They seem to think it will slow down short-term memory problems. At 93, having had a TIA and a stroke, being on a boatload of meds, having had numerous falls, almost totally blind from MacDegen, severe hearing loss, I don't see why she would not have some break-up in memory. Cripes, I go to the store and forget why I went, but I don't have Alzheimers. Sorry, I am very frustrated w/ the MDs who just toss out prescriptions as a reactive response; seems to me to be more CYA than healing. 3) Dx: Mom has had lots of those little tests, both in a Neurologist's office and while in stressful situations like being in ER or after admission from a fall which had her with scalp bleeding. They show some memory loss but only once that I know of, and this was recently while in an ER, did a doc comment that she had Alz. I don't see this doc's comment came from a definitive dx. Basirah > Darryl and all, > Thanks very much for your comments, I'd be very interested in anyone's [quoted text clipped - 17 lines] > prescriptions as a reactive response; seems to me to be more CYA than > healing. Bizzarre, many here have had problems getting the doctor to prescribe the stuff!  SignatureTumbleweed email replies not necessary but to contact use; tumbleweednews at hotmail dot com >Cripes, I go to the store and forget why I went, but I don't have >Alzheimers. Sorry, I am very frustrated w/ the MDs who just toss out >prescriptions as a reactive response; Basirah, are you taking your Mom to a neurologist who specializes in geriatric care? In my experience, specialists tend to be pretty conservative in handing out prescriptions because they are very knowledgeable about the risks vs. rewards of taking the drugs. If you feel your Mom's doctors are too quick to prescribe this that or the other, maybe you could get a second opinion? Your local Alz. Association might be able to refer you to a good clinic for diagnosis of dementia. ___ "This is an impressive crowd, the haves and the have-mores. Some call you the elites. I call you my base." -- President George W. Bush Basirah all I can tell you is what I have been told and what I have experienced. Aricept slows the progress of the disease in some people. It seems to be most effective when given in the early stages. (I believe it staved off my mother's Alz. progression for two years.) It seems maybe your loved one was unable to tolerate the side effects. There are other medicines for early-to-mid stage Alzheimers, could she try one of those? My understanding is that Namenda is effective for people with moderate to severe Alz., not early Alz. It hasn't helped my Mom's short term memory, but she has far fewer instances of not remembeirng who my brother is or not recognizing me... she doesn't take her top off and expose herself in the car anymore; she is better able to dress herself and realize it's time to change her Depends, and she there are fewer occasions when she acts like a child. I don't know if your loved one is far enough along for Namenda to help but if experts in medicine for the elderly think it can help, they're the ones who know best. Even if your loved one has another form of Dementia, maybe these meds can help anyway. ___ "This is an impressive crowd, the haves and the have-mores. Some call you the elites. I call you my base." -- President George W. Bush "Aricept slows the progress of the disease in some people." Thx for your note. We are not at all clear that Mom has Alz. and my understanding is that Aricept (?maybe even Namenda) is not useful on non-Alz memory loss/dementias. Does anyone have web sites which have info on trials using Aricept and trials using Namenda, and trials using a combo? Whether on Alz patients or non-Alz patients? Thanks, Basirah > "Aricept slows the progress of the disease in some people." > [quoted text clipped - 5 lines] > trials using Namenda, and trials using a combo? Whether on Alz patients > or non-Alz patients? I don't have studies, but my mom's doc is putting her on Aricept for vascular dementia. She says latest studies show it helps in some people -- worth a try. Time will tell. Alzheimer's is very hard to diagnose precisely in living people. (I suspect my mom may have it in addition to the Vasc Dem, but since she is terrified of having Alz, we'll leave the initial diagnosis as enough.) What is your underlying objection to her taking it? (Other than all of us hate to take and pay for totally unnecessary drugs.) Songbird I am the one having the objection - Mom is on boatloads of drugs. I truly don't seen anything but decline and I think the drugs have significantly contributed to it. So if there is no substantiating info that this drug will do her any good, and 4 of the 5 sibs don't really think Mom has AD, I object to yet another drug. Mom doesn't necessarily have an objection tho she is disgusted with the number of meds she is on. Mom was an RN and Hosp Admin so she is medically aware. In the past she felt that mis-medication of both her sister and brother-in-law led to their wretched feeble states at their end of life. I do think that the fears (death, dementia, etc) motivate her to take the meds in spite of her rational understanding of the deleterious effect of them. And all drugs have the possibility of some downside. Beginning of this year, her managed health care doc put Mom on the high dose of Aricept. She is also on Metropolol/Lopressor and they are in conflict. She was taken off the Aricept back in the mid-Spring. Sometime this past few weeks she was put on Namenda. I think my sister told me they would going to put her on the combo Aricept-Namenda, tho I don't understand how they are going to get around the conflict between Aricept and Metropolol. I did start a review of the literature by searching National Library of Medicine last night. It seems that either AD drug is an iffy proposition, may help one person and not another. The Namenda/Memantine site had some comments on combo therapy: http://www.memantine.com/en/studies/clinical_studies/combination_therapy/ This is of course Menantine's drug company site. Rose, thx for the info on the site for financial help - Mom is currently on a PACE regulated program and her meds are paid for; tho if she leaves that program then we may need to tap in to that site! Basirah > Mom doesn't necessarily have an objection tho she is disgusted with the > number of meds she is on. Mom was an RN and Hosp Admin so she is [quoted text clipped - 3 lines] > take the meds in spite of her rational understanding of the deleterious > effect of them. And all drugs have the possibility of some downside. Given the description you already gave us of this doctor, I think that it's time you help your mother find a new one! When you do, make sure that the new doc coes a *complete* review of all her meds and sends her for a full neuro-psych exam. >I am the one having the objection - Mom is on boatloads of drugs. I truly >don't seen anything but decline and I think the drugs have significantly >contributed to it. If I am getting your gist correctly, you feel that your mom's doctors have put her on too many medications and this may be making matters worse instead of better. If this is indeed the case, if I were in your shoes I would get a second opinion. I'd have my mom consult with a different geriatric specialist, let him know her medical ailments and symptoms, tell him what her regular health care providers are suggesting, and ask what he thinks of her drug cocktail. Some doctors do overprescribe, some underprescribe, and some, at the risk of sounding like Goldilocks, prescribe just right. Why not ease your mind and find out if your mom is getting the wisest care? ___ "This is an impressive crowd, the haves and the have-mores. Some call you the elites. I call you my base." -- President George W. Bush It is absolutely worth it to bring in a complete list of all the medications a person is on, and have it reviewed every now and then - not just for what medications a person is taking, but doses. When an older person has a constellation of health issues, and may be seeing various specialists, no one single doctor may have the big picture view of everything they are taking. I recall instances with my late father when a specialists prescribed a medication that my father should not take due to other health problems my dad had that the specialist didn't think to ask about. I actually caught some of these errors by looking up the drugs in a drug manual. No one was acting as a central clearing house when it came to the whole man. Older people can be very sensitive to drug side effects, and interactions, and may also need a lower dose than a younger person. So - a review by a knowledgable doctor with some understanding of dementias and geriatric issues can result in the long list of drugs being pared down and doses cut back. Mary G. > When an older person has a constellation of health issues, and may be > seeing various specialists, no one single doctor may have the big [quoted text clipped - 4 lines] > errors by looking up the drugs in a drug manual. No one was acting as > a central clearing house when it came to the whole man. it helps to use one pharmacist if possible, since pharmacists often have software that can check for drug interactions. also, if you take a list to the doc, be sure to add any over the counter medications to it, even if it's as innocuous as aspirin. i found it easiest to simply empty the medicine cabinet into a bag and take it all to the doctor visit. >Subject: Re: Aricept and Namenda >From: "Basirah" basirahnur@yahoo.com [quoted text clipped - 6 lines] >understanding is that Aricept (?maybe even Namenda) is not useful on >non-Alz memory loss/dementias. In the early stages, it is hard to be clear on whether someone has Alzheimers. My doctors weren't at all sure my mom had it, in fact they STILL haven't officially diagnosed it, and yet they put her on it three years ago. It's pretty obvious now that she has it, so I'm glad they put her on it to be on the safe side. Pfizer has an Aricept assistance program for low income seniors, just in case your mom might qualify. www.pfizer.com ___ "This is an impressive crowd, the haves and the have-mores. Some call you the elites. I call you my base." -- President George W. Bush >Pfizer has an Aricept assistance program for low income seniors, just in case >your mom might qualify. www.pfizer.com I'm in Australia, so I'd be interested in what Aricept costs under that program (just for a very rough comparison - couldn't find reference to it on the website). - Mod as a hooter! >Subject: Re: Aricept and Namenda >From: Anthony Shipley astechsystems@iinet.net.au [quoted text clipped - 6 lines] >I'm in Australia, so I'd be interested in what Aricept costs under that >program It's free. ___ "This is an impressive crowd, the haves and the have-mores. Some call you the elites. I call you my base." -- President George W. Bush |
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