I rarely report on drugs, but because I do have a number of early reports on the four drugs approved for use with Alzheimer’s, I wanted to provide this update.

The four drugs are donepezil, rivastigmine, galantamine and memantine. This review is said to be the first to rank their comparative safety and effectiveness. It used evidence from 142 clinical trials published between 1996 and 2015. The number of patients in each study ranged from 13 to 2,045, and the review evaluated a total of 33,889 patients.

Donepezil was the most effective medication for Alzheimer's dementia across all effectiveness outcomes, including cognition, behavior and overall health, according to the study. It was also the only cognitive enhancer that produced effects that could be observed clinically, not merely statistically.

However, patients who took donepezil were more likely to experience side effects including nausea, vomiting and diarrhea than those who received a placebo.

Previous research found that these drugs don’t improve cognition or function in people with MCI, and these patients experience significantly more nausea, diarrhea, vomiting and headaches.

Memantine plus care program dramatically better at reducing Alzheimer's symptoms than drug alone

A small study found that combining a specific care management program with memantine multiplied the drug’s ability to improve daily function by about 7.5 times.

The Comprehensive, Individualized, Person-Centered Management program (CI-PCM) includes caregiver training, residence assessment, therapeutic home visits, and caregiver support groups.

In the 28-week, blinded, randomized controlled trial, 10 patient-caregiver groups enrolled in the CI-PCM were compared against 10 pairs receiving standard community care. All patients were taking memantine. Participants were assessed at the end of the trial using a recognized tool called Functional Assessment Staging (FAST), which measures losses in the ability of a person to independently carry out daily activities, such as dressing, bathing and toileting.

Caregiver training included "memory coaching" that teaches patients how to accomplish skills they lost.

The findings were presented July 16 at the Alzheimer's Association International Conference 2017 in London.

Tricco, A. C., Ashoor, H. M., Soobiah, C., Rios, P., Veroniki, A. A., Hamid, J. S., … Straus, S. E. (2018). Comparative Effectiveness and Safety of Cognitive Enhancers for Treating Alzheimer’s Disease: Systematic Review and Network Metaanalysis. Journal of the American Geriatrics Society, 66(1), 170–178.

Older news items (pre-2010) brought over from the old website

Benefit of memantine in the treatment of Alzheimer's disease not proven

A review of the use of memantine for patients with moderate or severe Alzheimer's disease has concluded there is no scientific evidence of any benefit to this group, either to patients or caregivers. The review covered 7 studies, involving 1913 patients. The longest study lasted 28 weeks. The main problem was a lack of reliable evidence, and a lack of studies of longer duration, as well as a lack of research with relevant patient groups.

Memantine works differently than thought

New research shows that the drug memantine, praised as "the first and only representative of a new class of Alzheimer drugs", in fact works similar to other existing compounds, and although the data do confirm that memantine shows promising aspects for the treatment of Alzheimer’s, this is only in a narrow concentration range. Its complex pharmacological profile requires careful considerations concerning suitable doses and suitable patient groups.

Drever, B.D. et al. 2007. Memantine acts as a cholinergic stimulant in the mouse hippocampus. Journal of Alzheimer's Disease, 12 (4), 319-333.

Some benefit from memantine for moderate-to-severe Alzheimer’s

A review of nine published studies comprising 2,339 participants has concluded that memantine has a small but significant cognitive benefit for moderate-to-severe Alzheimer’s patients. It also seems to prevent the onset of agitation. Although there was some indication of benefit for those with mild to moderate Alzheimer’s, the effects were not significant. Researchers caution that the drug treats the symptoms only, slowing the progress of the disease only.

Sastre, A. Areosa et al. 2005. Memantine for dementia. The Cochrane Database of Systematic Reviews, Issue 2.

New drug approved for moderate to severe Alzheimer's

The FDA recently approved memantine for treatment of moderate to severe Alzheimer’s. The drug has been used for some 20 years in Germany. While memantine significantly improved performance in Alzheimer’s sufferers in studies, the effect, as with all Alzheimer’s drugs currently in use, is small.

Tariot, P.N., Farlow, M.R., Grossberg, G.T., Graham, S.M., McDonald, S. & Gergel, I. 2004. Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: A randomized controlled trial. JAMA, 291, 317-24.

New Drug for Moderate-to-Severe Alzheimer's

Four drugs — donepezil, galantamine, rivastigmine, and tacrine — are approved for treatment of mild-to-moderate Alzheimer's disease in the U.S., but there are no approved treatments for severe AD. Now an industry-sponsored study has examined memantine for this use. The study involved 252 patients with moderate-to-severe AD, over a period of 28 weeks. Patients were evaluated on 7 tests of cognition, functional capacity, and behavior. Outcomes were significantly better with memantine than with placebo on 4 of these scales, and no significant adverse events were noted. It is not clear yet how clinically meaningful these small improvements are. Memantine has been approved for use in Europe.

Reisberg, B., Doody, R., Stöffler, A., Schmitt, F., Ferris, S. & Möbius, H.J. 2003. Memantine in moderate-to-severe Alzheimer's disease. New England Journal of Medicine, 348, 1333-41.