In my experience, Memantine has a synergistic effect with cholinesterase inhibitors over slowing the rate of cognitive decline for patients in moderate and severe stages of dementia due to Alzheimer's disease. Its effects in other dementia syndromes are usually unremarkable.

Regarding behavioural symptoms, there are several papers that show a good profile of this drug for improvement. Nonetheless, I do not see such benefit in all treated patients: while some of them actually turn out to be less agitated with Memantine, others have no response.

Last year, I published a paper with my group on the Journal of the Neurological Sciences, entitled "Pharmacological modulation of cognitive and behavioral symptoms in patients with dementia due to Alzheimer's disease" (DOI: 10.1016/j.jns.2013.10.015). You may find some answers there.

I hope that my answer has clarified your views on this important subject.

http://dx.doi.org/10.1016/j.jns.2013.10.015

That is great information! It does help!  will definitely take a look at your paper. Thanks you! 

Hello Sandra, I'm an old age psychiatrist and see many patients in care homes that fit this picture. The  evidence generally shows a modest improvement overall in bpsd for memantine and it is well tolerated. There is a view that it can be best in combination with ACHEI eg donepezil in this group,but is also used alone. Although the evidence doesn't show a large effect, if I link this to what I see clinically, some people improve greatly, some show no change (but it may still be working to prevent worsening), and some people are worse (not many), and in my experience, the proportion in each of those groups is about the same, so overall, trials will struggle to show a statistical improvement across a large number of people.

If you can improve a person's quality of life, it's usually worth a go, as if there are adverse effects,memantine can be stopped abruptly without any problems. I usually try as long as eGFR is over 50.

Hope this helps

Kind Regards 

Sally

Hello Sally,

Thank you so much for that informative answer! It is also nice to know what the acceptable eGFR limit is, as I work with the frail elderly and medically complex population. Thanks again and I will certainly be able to apply this information to my practice.

Kindest regards,

Sandra