The Milwaukee Journal Sentinel - January 21, 2004
MILWAUKWEE _ Providing a glimmer of
hope for a new treatment approach, a recently approved
Alzheimers drug, when combined with an older
drug, was significantly better at slowing mental decline
than the older drug alone, according to a study published
Wednesday in the Journal of the American Medical Association.
Researchers say using a drug cocktail to attack this
incurable brain disorder might allow patients to avoid
institutionalization for months or more, or maintain
the quality of their lives until they die of something
However, some physicians who treat Alzheimers
patients cautioned families about getting too excited
about the new drug memantine.
"Its nice to have another drug," said
Mark Sager, a professor of medicine at the University
of Wisconsin-Madison and director of the Wisconsin
Alzheimers Institute. "Unfortunately, this
is not a wonder drug."
Sager noted that patients in the JAMA study already
were severely impaired, and he questioned how much
benefit the drug combination would be for most Alzheimers
The study involved memantine, which became available
Far from a cure, the drug, at best, can slow cognitive
decline in people with moderate to severe Alzheimers.
But its arrival in pharmacies has been long anticipated
by the families of Alzheimers patients.
"As soon as people heard there was a new Alzheimers
drug, they began calling right away," said Stephen
Gardner, spokesman for the Alzheimers Association
of Southeastern Wisconsin.
About 105,00 people in Wisconsin and 4.5 million nationally
have Alzheimers. Both numbers are expected to
rise dramatically in coming years as the population
Drugs already available on the market are intended
primarily for people with mild to moderate Alzheimers.
Memantine, also known as Namenda, can be used for
patients with moderate to severe symptoms.
The older Alzheimers drugs work by delaying
the breakdown of the neurotransmitter acetylcholine,
which is needed for brain cells to communicate. Memantine
works by affecting a different brain chemical, the
neurotransmitter glutamate. Glutamate is crucial to
learning and memory, but Alzheimers patients
produce too much of it, thereby killing brain cells.
Memantine blocks the effects of excess glutamate.
Part of the excitement about memantine is the possibility
of using it in combination with other Alzheimers
drugs.And thats what was done in Wednesdays
Funded by Forest Laboratories, which sells memantine
in the United States, the study looked at a group
of 404 patients with moderate to severe Alzheimers.
One group received the Alzheimers drug donepezil
(Aricept) and a placebo. The other group got memantine
and donepezil. After six months, the memantine group
had a slight (0.9-point) increase in their scores
on a cognitive test, compared with a 2.5-point decline
in the placebo group. In another measure that looked
at daily living skills, the memantine group had a
2-point drop compared with a 3.4-point drop in the
Pierre Tariot, the studys lead author, stressed
that the drug combination did not result in a cure,
but a stabilization of symptoms over six months.
But if patients are able to live at home for an additional
six months or a year before they must move to a nursing
home, "thats a big deal," said Tariot,
a professor of psychiatry medicine and neurology at
the University of Rochester Medical Center. "What
is that worth?
"This is a treatable illness." For years,
many neurologists have thought that combination therapy
would be the future of treating Alzheimers,
said Piero Antuono, a professor of neurology at the
Medical College of Wisconsin and Froedtert Memorial
Lutheran Hospital. "This is the beginning of
that trend," he said. Antuono said many caregivers
have waited for memantine to become available.
"Weve had several families who bought the
medication from Europe for the last year," he
Memantine costs about $143 a month in Milwaukee area