MIND in memory care
Moving In Nurturing Directions in Memory Care

Cindy's Blog


I just came across a small study by Tomislav Majic and colleagues from Charite Hospital in Berlin, and I feel I just have to comment on this. They noted that as a person's dementia worsens, disruptive behaviors, depression, and apathy tend to increase. In this study they analyzed data on 304 dementia patients from 18 facilities in Berlin. They found that while the anti-dementia drugs (the cholinesterase inhibitors Aricept, Exelon and Razadyne, and an NMDA receptor antagonist--Namenda) were rarely prescribed, patients instead were usually being treated with neuroleptic drugs. One definition of a neuroleptic drug is a "tranquilizer used to treat psychotic conditions when a calming effect is desired." These drugs can have serious and life threatening side effects and should only be given when less harmful drugs have failed. That's why the FDA has given them all "Black Box Warnings." It's now the "gold standard" for the best dementia treatment options that one of the cholinesterase inhibitors PLUS Namenda be given together. That combination has been shown to reduce agitation and aggression and slow the progression of cognitive and functional decline over either drug alone, and over no treatment. Of course, non pharmacologic options should always be ongoing--things such as tailored activities, exercise, established routines and a well trained staff to be able to appropriately redirect a person with dementia. I have seen what these drugs can and cannot do, and if this person with dementia is my loved one, I want them on the anti-dementia meds. That's the best we can hope for now since there is still no cure. We can only hope to slow the progression a bit and at the same time, increase their quality of life. The argument for anti-dementia drug combination therapy was made by a study sponsored by NIH (National Institute for Health). This was not a drug company sponsored study. It was carried out in the Memory Disorders Unit at Massachusetts General Hospital and conducted by Dr. Atri, et al. The results were published in the September 2008 issue of Alzheimer Disease and Associated Disorders and included data from 382 AD patients collected over the course of 15 years. They were trying to see if there really was any measurable benefits to giving these two anti-dementia meds together versus only a cholinesterase inhibitor, or versus no treatment. They measured cognitive performance over time as well as functional dependence over time. For cognitive results, the data showed that untreated patients had 3 to 4 errors per year on testing. The combination of Namenda plus a cholinesterase inhibitor decreased that deterioration by 2 errors per year. When 1 error per year could mean the difference between a person remembering the name of their relative, this is very significant. For functional outcomes, the combination therapy again showed increased abilities over the period of decline over just the cholinesterase inhibitor alone, or no treatment. That could mean the different between a person being able to stand up when asked to at the end of 4 years. This has huge implications for facility caregivers as well as family members.

I must disclose to you that I am on the Speaker's Bureau of Forest Labs for their dementia drug Namenda, however, even if I were not, my experience has shown me without a doubt that these drugs do help and do not have the severe side effects of the antipsychotics. I have no qualms whatsoever about recommending these anti-dementia drugs, and I urge you to ask your physician to try them before resorting to the more dangerous drugs. It's always, always, always a guessing game when it comes to which drugs will work with dementia, but if meds are required, you should always opt for the least harmful drugs first.

Dr. Majic's article was seen in the current issue of Deutsches Arzteblatt International (Dtsch Arztebl Int 2010; 107[18]: 320-7). We have to do better at treating these elders in facilities, and combination therapy of the anti-dementia meds is a huge first step, so I urge you to push for it.

Alzheimer's and Dementia Counseling and Education
call Cindy Keith of M.I.N.D. in Memory Care