I just came across an article suggesting that combined therapy with a Cholinesterase Inhibitor (Aricept, etc.) and Memantine (Namenda) improves behavior in patients with AD, thus relieving some of the stress on the caregiver. Here are a few quotes from the article:
March 10, 2010 (Savannah, Georgia) — Caregiver distress is significantly attenuated when patients with moderate to severe Alzheimer’s disease (AD) are treated with a combination of extended-release memantine plus a cholinesterase inhibitor (ChEI) vs ChEI monotherapy, according to a multicenter, randomized, double-blind, placebo-controlled trial….. "The extent or amount of caregiver distress is the 1 factor that most closely correlates with early nursing home admission," Dr. Grossberg told Medscape Psychiatry. "So if we can ease stress on caregivers, we can enable them to keep patients at home longer, keep them out of the institutional setting longer, which is good for the patient’s quality of life and good financially." Individual items showing significant differences between groups at endpoint were agitation and aggression, irritability and lability, and nighttime behavior, all in favor of the additional extended-release memantine arm, investigators add. "The instigating factor or trigger for institutionalization in AD patients is behavior — things like agitation, aggression, irritability, and nighttime behaviors. So when caregivers can’t sleep, they get exhausted," said Dr. Grossberg. "In this particular study, we were able to show statistically significant benefits in decreasing these problem behaviors with the combination approach, all potentially good outcomes for caregivers of AD patients. "This is very important," she added, "physicians should worry about caregiver stress. When I’m working with families who have a patient with AD, I have to take care of the caregiver, because they are the lifeline. No matter what happens to the patient — whether they get institutionalized or stay at home — the caregiver is still very active and involved in the patient’s care, and we have to take care of them," said Dr. Whyte.
I truly believe this has been the case with my DH. We got a DX very early and he was immediately put on Aricept; then as soon as Namenda became available, he was on it.
Would that we had more doctors like Dr. Whyte! (And, of course, you, Marsh).
The first neuro who saw my DH put him on Aricept. I asked him about Namenda because I had read that they work better together. He flatly refused! I didn't care for him any way, he was too eager to get us out of the office FAST. When I told our PCP I wan't impressed with this guy he had his nurse call and get us an appointment with a different neuro who is great. He put DH on Namenda and ran all sorts of tests. The first appointment we had with him was over an hour.
DH was put on Aricept and Namenda but psych dr took him off both because of a perceived drug interaction because he was on other meds. I think the combo helped his cognition but when he was put on Namenda alone (before Aricept) it made him physically aggressive, paranoid and abusive. Nurse in ALF told me at leats 25% of her patients when put on Namenda alone became physically aggresive and agitated.
Marsh, even more than recognizing the improvement with cognition with the pair, the fact that they're recognizing the importance of caregivers is HUGE!
My DH was first put on Exelon. We were given to understand the difference between Exelon and Aricept is one is a pill one a patch. Later he was put on Namenda but after 3 days he had to come off that drug as it made him really dizzy.
My DH was on Aricept alone for about 1 year. Then Namenda was added. The combination definitely helps him with daily activities and has diminished sundowning. A couple of months ago he started taking Axona - again I saw benefits. This week he started taking Nuvigil. This drug combats daytime sleepiness. He still takes an afternoon nap but otherwise is more alert (and is starting to show initiative) than before. Geriatric psychiatrist explained that AD still marches on but the drugs help very much with daily activities, mood, and sleep/wake patterns. Therefore, caregiving is easier, now that we seem to have an effective combination of drugs.
I agree that the combination of Aricept with Namenda helped DH during the time he was taking it. He started with Aricept when he was diagnosed in 2005. I was told that the benefits of Aricept would last about 18 months. Namenda was added in 2007 and I noticed improvement. Marsh, thank you for the work you will be doing on behalf of Caregivers etc. DH refused to continue to take Namenda after a month or two, not because of the drug, but because he was so angry and hostile that he was being given medicine by a doctor that kept tricking him with those stupid questions. This was just a very very bad time..and that time continued until I was actually at my wits end and ready to place him. The doctor gave me instructions on what was needed to have him committed for a psych eval. He also gave me information about the alzheimers facility etc.. BUT he prescribed Risperadone and that saved the day literally. DH is generally in good spirits, he's willing to help do anything he's asked. As long as we can keep things going along this well, even though I'm trying to make plans for the future, I will indeed be able to keep him at home longer. Again, thank you.
I have a question that I hope someone can help with. As I said my DH is on Exelon and when Namenda was added he got dizzy and the Namenda was stopped. I wonder if anyone has experience with say the Exelon being changed to Aricept and then the Namenda being added again and if it made a difference with side effects? We have a neuro appt next week on Monday and I am wondering if I should bring this up at the visit.
I got the neuro to bump his diagnosis up to moderate so we could get the Namenda (VA will only give when they are in the boundaries of what the FDA prescribes). He was so tired during the day I have dropped the morning pill and just give the night. I think next week I will try adding the morning pill back and see if he still has the problem. He hasn't complained of any other side effects from it and I haven't noticed any cognitive change. Will see what the full dosage does. If no change, may just drop it and leave him on just the galantamine.
My dh has been on Exelon for 18 months and I asked the neuro recently for Namenda, hoping that it would slow the rapid decline I've been seeing. He readily prescribed a starter kit. But already on the second day dh was so agitated and angry -- I was shocked, not having had any of this since he was started on Risperdal. But after a continuation on the third day I just dropped the Namenda. Probably should have given it more of a chance but I just didn't feel I could deal with the nastiness. It stopped right away. (Strong possibility btw that dh has FTD)
My DH was on Aricept first and about 6 months ago we asked the doctor if he would recommend Namenda. He had decided to that even before we asked, so we started it. After a couple of months on the combination, he became very agitated and aggressive. That's when he was put on Seroquel and Namenda and taken off the Aricept. He is like a different man since last year. Oh, he still has his bad days, but, overall, the difference is remarkable. He is actually looking and acting better this year than last. I think he'll even go on some small weekend trips this year, something he wouldn't even think of the year before. I'm very grateful for the Namenda and Seroquel, and he hasn't had any side effects at all.
We had the neuro visit on Monday. The doc wants to start the Namenda again, said the dizzies are not normally a reaction to Namenda. I get discouraged reading about the side effect of nastiness or aggressiveness. The cardio doc today looked over the BP meds and does not want to change meds or doses but recommended spreading the doses out through the day. Some like to take them at one time but this could cause the light headedness. So tomorrow we see the diabetic doc ( who will not be happy with DH's overall values values once the glucometer rats him out)..but this could also be a cause..getting him to take the insulin as he should before lunch and dinner is a battle.. Then next week to the ENT to see what is going on if anything in those ears..maybe wax,,anyway if all those things check out ok then ??? I hate all the meds and changes in doses, I is a lot to keep up with, I told the cardio doctor I need a secretary my file drawer ( my mind) is overflowing with all the data I have to keep track of these days.
My husband has been on Aricept for a number of years. Two years ago we added Namenda. I don't think that there was any change at all with the addition of either one. His PCP and I have discussed it and since we have no idea whether or not either one is doing any good, he is reluctant to stop it.
My DH has been on Aricept since 2005. The neuro added Namenda about two years ago and strangely enough, after a few day on the starter kit, he was much more confused. Contacted the neuro, he said discontinue. I did and DH returned to normal. Tried Namenda a second time about 6 months later. Same results. Since that time he has been in a Dimebon/Aricept trial and is now on Dimebon open label. Neuro tried the Namenda about two weeks ago and he seems to be improving somewhat. No explaining some of these things.
Yes, isn't it amazing the different reactions they get with medications? Without the Namenda and Seroquel, I'm not sure what I'd be doing now, because he was getting so difficult to handle. With it, he has had a remarkable change. No more hallucinations (the Namenda) and no rage. He gets very angry at times, but I think I've learned (at least some of the time) to walk away, even though I feel the anger inside of me, because a few hours later, he's back to his good self again.
A new problem to add about the Namenda...my DH was more alert after almost 2 weeks on 1/2 dose..Dr. said add the second 5mg so I started him on Friday. Sunday he slept most of the day. Yesterday and today he has complained of being SO tired and has slept a lot. I'm going to call Dr. tomorrow and see if he needs to go with the half dose for a while longer. Anyone had this problem? I was so pleased that he hadn't had the problems he had experienced when he tried Namenda before...another day!!!
Audrey--what I'm about to say may not apply, so please do follow through with your Dr., but with some of the meds. my DH has been on, we ended up going with a non-standard dose--right for him but not the usual dose Dr.s generally prescribe. We've never worked with Namenda, but if 1/2 dose works okay and a whole dose is problematic, it would seem the 1/2 dose is right for him---or something else entirely. My DH has VaD and when we had to change some of his psych meds because of extended exposure, one change worked out just like clockwork. The other had us trying Zyprexia--may as well have been water; then Seroquel--slept from dose to dose; on to Risperdal--worked great, butmajorjoint pain and muscle stiffness, Dr. said it caused. Finally tried Geodon. Started witrh 40mg at night--ok. Upped to 80 at night--better,but seemed to run out before next night so added 40 at midday. Doing quite well--not perfect but pretty good. Dr. said to up to 80 a.m. and 80 p.m.(normal full dose). Back to confusion, tempermental, etc. Back to the Dr. Reduce back to 40/80--right dose for DH.
Audrey, when my hb went to the full dose he also complained of being extremely tired. Not sleeping tired, just tired. I cut back to just the 10 mg at night since feeling of tired is a side effect in a small percentage. I started back adding 1/2 a 10 mg pill in the morning and the 10 mg at night last week. He wasn't saying too much about feeling tired until the trauma of this last weekend. I have his pills set so next Tuesday he starts back on 10mg in the morning and 10 at night. If he starts to complain of tired I will go back just to 10mg at night. I spoke with his neurologist when this first started and she said to try for a couple months but I couldn't wait that long. He was so tired he couldn't do anything but sit. He didn't even have the energy to do his word search. That is not a good trade off - chance to slow it down if it means giving up what life he has. My neuro is also of the thinking that it is questionable how well any of these drugs work. My conclusion: if they work the combo is better.
If you have read here, you will see that the doctors often give us the choice of how to handle it. I would certainly speak with the doctor but also remember you are the one closest to his well being and you will probably have to make the choice of which trade off is the one you want to live with. It is an awesome and sometimes frightening responsibility we have.
Thanks for the suggestions...I'm waiting for the Dr.'s office to open this morning. I know being tired is one of the side effects but he didn't sleep at all last night. (I left off the night dose of Namenda last night). I gave him a melatonin which usually works if he has any trouble sleeping but that didn't work. I'm of the opinion that the 5 mg. in the morning was working, he seemed some better and I'm going to mention all this to the doctor....and ask what I need to give him to make him sleep!
Go to the above link - it is an article about the combo and it may help you to start understanding. I know the Aricept works one area of the brain while the Namenda another. My FIL has been on just Namenda for 9 years now (25+ years into the disease) and it seemed to stablize his physical abilities vs memory for a longer time.
We can't either. He was showing signs in 1985 and was diagnosed about 1987. None of us can believe he is still going. He was on no AD drugs until my MIL died in 2001 and he was then placed in the VA Alzheimer Unit in Bedford, MA. That is when they put him on Namenda. He was still could use the bathroom, feed himself, etc. but he didn't really know us. We took him for a couple days to their campground and he never was incontinent -never even considered that a problem. He was a runner, and that was our biggest problem. No matter what we did, it seemed within seconds he was out the door which resulted in very little sleep. The same problem at their house - no matter what type of lock or security he always escaped. That is when he had to be institutionalized for his own safety. He did recognize my MIL at the funeral - when we took him up to the casket he had tears running down his cheeks as he bent over to kiss her. My MIL gave him Gingko, St John's Wort, vit C & E, and of course tea numerous times a day (anyone been to New England and know they have to have their tea time). She also kept him active, first cutting and painting wood (I have a skunk he made), then she bought coloring books and had him tracing the pictures. She devoted all her time to him which is, what we believe, led to her massive heart attack.
We believe the Namenda and his will to live or fear of dying has attributed to him living so long with this disease. His parents and siblings that died of AD did not live this long. We pray my hb and his sister do not follow their dad's lifespan. Since they were diagnosed at an earlier age, hopefully they will not.