There has been some downward change in short term memory and confusion about when and for how long we're going somewhere, but otherwise he functions very well. Drives, when I'm with him. He uses his iPhone, the computer and even day trades stocks. So, when his primary care physician prescribed Namenda I was surprised, as I thought it is for moderate to severe dementia. With the possible side effects, I'm not sure he should take it. What to do?

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There are side effects with every medication.
This is one of the reasons before taking any medication you need to weigh the risk VS benefit.
My Husband was on Aricept for many years the Dr. added Namenda but the difficulties we/he had with each change of dose titrating on the medication was not worth it so we discontinued.
did any of the medication work? Who knows. I have no idea what his decline would have been without it.
At some point the damage is there and you wonder if it is worth it delaying the decline knowing that there is not a way to reverse the damage that has been done.
This is a sit down discussion you should have with your husband since he seems to be high functioning now. Ask him what his goals are, what he wants you to do, what he wants to do.
Take that trip that you have put off...
Get all your paperwork in order....
Sign a P.O.L.S.T. (like a DNR but more detailed)...
Talk about the possibility of placement in a Memory Care Facility. Do NOT promise that you will not do that. The man you promise to keep at home will disappear. Discuss what event will make it impossible for you to care for him. (I said I would keep my Husband at home as long as it was safe for him and for me)
These are tough discussions but best to talk about them now. I could never get my Husband to talk to me about any of this.
Helpful Answer (11)

Why did the doctor prescribe it? Is his PCP a GP? A geriatrician? Has your husband been seen by a specialist, such as a neurologist or a geriatric psychiatrist?

What made the doctor diagnose dementia, instead of mild cognitive impairment? What kind of testing was done?

Sorry for all the questions. Perhaps the most important question at this point, and one you should ask the doctor, is what improvement does he expect to see once this drug is working? How will you know that it is working? Can you expect improvement in short term memory? Will he be more steady on his feet? Calmer? Specifically what symptoms might the drug improve?

Namenda will not cure the dementia (or MCI) and it will not slow down its progress. It is effective at reducing certain symptoms for SOME people. The only way to know if it will work for a person is to try it. As with any drug, side effects are possible. If they occur you can discontinue the drug.

This is a trade-off situation. Do the potential benefits outweigh the side-effect risks? You need more information about what the benefits are expected to be.
Helpful Answer (10)

Namenda is a very interesting topic for me. Check the appropriateness of this drug thoroughly before you trust the doctors giving it to your loved one. Here is why...

Years ago, my Mom primary physician gave her Namenda. After a while I noticed that Mom was weak and felt "blah" (a non-medical term which describes the feeling very well :-) I changed the time I gave it to her, so that she would go through the "blah" time during her sleep cycle. This change improved her state somewhat but not totally.

After a year of Namenda (a very expensive drug as well) I happen to run into the sales rep for that drug company coming out of the doctors office. I asked her a few questions about the drug and guess what I was told? Namenda does NOT work alone. You must partner it with Aricept for it to have any results whatsoever! And the results are not preventive, they only slow down the disease relative to the level of dementia appearing.

Further, she shared that Aricept should not be given to patients with cardiac issues, which my Mom also had. Immediately I took Mom off a drug that was not doing anything for her but diminish the moneys in her pocket. Her vitality and joy of life returned. Is it not more important to have the time you have left with quality of life?

General doctors do not know the biochemistry of all the drugs they prescribe. Do take your loved one to a gerontologist and make sure that the drugs you are offering be the right ones to have the results you expect.
Helpful Answer (9)

GP said memory loss might slow down with Namenda? I don't think any of the current generation of dementia drugs actually has any impact on the rate of decline. If it works, it might improve memory in the present and for as long as it keeps working, but the pathology in the brain continues at its own pace. If you try it and you see some improvement, great. If there is no noticeable improvement or if there are unpleasant side effects, have the doctor discontinue it.

My husband took Aricept from the day he was diagnosed. It was helpful, especially in eliminating hallucinations. Aricept generally works better for the type of dementia he had than the type of dementia that it was developed and approved for. He took it the entire ten years of his journey, just because he was doing very well and the doctor didn't want to "rock the boat." When he went on hospice care it was discontinued, but it became clear that it was still working and that he was more comfortable taking it, so it was added back in.

I am definitely not anti-dementia drugs. But it should be acknowledged that no drug works for everyone, no drug cures or delays dementia progression, and if a drug is not working in the present there really isn't much point in continuing with it. The generation of drugs being worked on now will be a whole new ballgame, but what is currently available has real limitations (and I don't think patients or even non-specialist doctors necessarily get this message).
Helpful Answer (8)

Building on the answer from Isabelsdaughter, my Mom with LBD and vascular dementia was prescribed a dose of 10 mg. Of Namenda twice a day. WAY too much - she swung between zombie and anxious hyperactivity. 10 mg. Once a day was still too much. We now do 5 mg. Once a day and have been doing that for about 8 years. Originally, we had to split the pills because it wasn’t offered at that low a dose. Now it is, which tells me that reducing the dosage must have been pretty successful. It was for her. The hallucinations have disappeared, her ability to find words is adequate most days, she exhibits less confusion about her surroundings and has calmed down a lot. Can’t guarantee the Namenda did all of that, but I’m not going to be messing with something that seems to be working. I find it useful to take on the role of the scientist observing the experiment and making intelligent observations and decisions. I try not to fall back on my early training that doctors know everything. When it comes to dementia, they are still learning, too, and need us to be good and equal partners. (Whether they like it or not, sometimes.)
Helpful Answer (7)

My father has early-mid stage dementia diagnosed 2 1/2 years ago. Has been on Namenda since day 1 as prescribed by his Neurologist. No side affects.
Helpful Answer (4)

Neither Aricept nor Namenda seemed to help my Dad in any noticeable way, and they were constipating and very expensive. I suggest allowing your husband to feel as good as he can for his last years, so try the drugs if you wish, but choose whichever path seems to make him the most comfortable, which in his case might be no drugs.
Helpful Answer (4)

Talk to your local pharmacist about your husband's symptoms and ask if the current medication is appropriate or is there another medication recommended for your husband's illness. Ask the pharmacist what he/she has seen in the latest clinical studies for this drug or any other drug being used to treat your husband's condition. Pharmacists are the experts in drugs.

Doctors can get nicely compensated by the drug companies - especially newer drugs hitting the market. There's not that much in compensation for generic drugs. I'm not saying your husband's doctor is one of the compensated - but there are plenty of doctors that do receive some financial gain.

Tell your husband's doctor your concerns and how did he/she decide on this drug for treatment. If the doctor isn't willing to take the time to explain or is dismissive, then it's time to find a new doctor - now. You need trust in any healthcare provider. You don't need hours of explanation, just a few detailed minutes of why this versus that drug or that other drug was chosen as the plan for treatment. You also need to armed with your concerns and not be afraid to stand up for what you believe is right for your loved one, i.e., if your gut tells you this isn't the drug for your husband - then find another doctor to consult.

As advocates for our ill loved ones, we also need to be researchers and be even more knowledgeable about what's appropriate and not appropriate for our loved ones.

With any pharmaceutical or any treatment, frankly, you must weigh the risks vs benefits. All drugs have side effects, it's just a matter of what you're willing to live with for quality of life and not quantity of life.
Helpful Answer (3)

My mom was diagnosed with Alzheimer's in 2009. They started her on Namenda and Aricept. I believe it helped stave off or lighten some of the symptoms for many years. She was able to function well, going shopping and even going to work with me. As the disease progressed (stage 6), it finally was at a point where we decided to take her off both. We did so slowly. She is now at stage 7. Her progression wasn't actually slowed down but she did retain the ability to function... At least that is what I think. You never know because we never had to deal with her without the drugs. I don't think there is a good way to know, each person is so different. It is all a guessing game... We just have to go with or feelings and hope for the best.
Helpful Answer (3)

Although it's true that individuals have different responses to medications, it's always a good idea to check on what the best-available scientific research finds.

Namenda is FDA-approved for the treatment of "moderate-to-severe" dementia. In research studies, it wasn't found to be effective for mild dementia.

@sammy222, based on how you describe your husband (e.g. driving, "functions well"), it sounds like he is still in mild stage.

I don't know why the PCP prescribed it. It's actually quite common for doctors to prescribe medications without having a very good reason or scientific justification; I think it is related to the pharmaceutical advertising and also their desire to "do something" in order to feel that they are helping.

Now, if your husband was having a particular symptom that the doctor was struggling to treat, it might be reasonable to give Namenda a try, especially after trying better proven approaches. But ideally, the PCP and your husband and you would clarify which symptom you're hoping to improve, and then you'd follow that closely for several weeks, and then if no improvement -- or too many side-effects -- you'd discontinue the medication.

Incidentally, the same "give it a try and see if it helps" is recommended for the medications that are FDA-approved for mild dementia, such as Aricept, because they only seem to help some people, not all (probably not even most).

This ideal process doesn't happen very often though.

I would recommend you ask the doctor more questions about why he thinks this will help your husband. In my experience, it's well tolerated by most older adults, probably less risky than many other meds people take for years. But still, why take something unless it's helping or likely to help? Good luck!
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