Expensive Dementia Drugs --- Ineffective? Harmful?

If you are age 60  or over, or if you have any degree of concern or responsibility for anyone over age 60, you should know about the book "Worst Pills, Best Pills" and use it frequently as a reference. The information contained in both this published volume and in the monthly companion newsletters reflect the highest degree of academic excellence  and integrity in research. The material is directed to "older adults" -- meaning over 60.

The May issue of the newsletter, Worst Pills, Best Pills News, was in my mailbox today. Page three features an article entitled "Memantine:  Still a Poor Choice For Alzheimer's Disease".

The trade name for memantine is Namenda. We've all seen the direct-to-consumer TV commercials advertising this drug, as well as similar ads for Aricept. As a matter of fact, the ads tell us that the two drugs used in combination are more effective than either drug taken alone.

Though the ads appeal to the compassion, devotion and sense of protection that a family member feels for someone living with dementia, the true story of the effectiveness of these drugs is quite different. In fact, Public Citizen's Health Research Group, the official name of the organization that publishes this newsletter I'm quoting from, categorizes this drug as a "Do Not Use" drug. They cite as the reason that there is no  persuasive evidence that it is effective, "making the drugs known risks unacceptable."

The risks refer to common side effects which are these:  dizziness (a risk factor for falls in older adults), headache, constipation, difficulty breathing, hallucinations and confusion.

Rare side effects include inflammation of the pancreas, kidney failure, bone marrow failure, heart failure, liver failure --- the list continues.

And what does the Federal Drug Administration (FDA) report to the public regarding the drug's effectiveness in the face of these side effects?  The newsletter quotes an FDA medical officer: "Only a small minority of patients treated with memantine showed even a minimal or moderate improvement, with no patients showing a marked improvement, and the most common response being no change."

The authors of a study done in 2011 concluded "… evidence is lacking for the benefit of memantine in mild Alzheimer's disease, and there is meager evidence for its efficacy in moderate Alzheimer's disease."

Most telling is the drug' s product labeling which, according to this article, states: "At this time, there is no evidence that memantine prevents or slows neurodegeneration in patients with Alzheimer's disease.

So let's look at what Big Pharma, even in the eyes of the FDA, is pushing:
A drug that is very expensive, a drug that has common, serious side effects, a drug that shows "meager evidence for its efficacy."

As far back as twenty years ago, I heard respected geriatricians tell their audiences the same thing that I have written here.  One doctor put more of a face on it, telling us, "If you have an aunt who has been diagnosed with Alzheimer's, forget Aricept and Namenda.  Take the money that you would have spent on those prescriptions and take her to her favorite fancy restaurant every month or more often.  It won't cost nearly as much and it will do her more good than the drugs."

That advice is still good.  Now to update my Advance Directives Form:  if I am diagnosed with dementia, I do not want to be given Aricept or Namenda.  I refuse that treatment.

And another update to my directives:  I do not want to be put on thickened liquids.  We haven't talked about those studies have we?  "Watch this space."