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 Newbie with treatment/prescription questions 
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Joined: Mon Jun 20, 2011 10:04 pm
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Post Newbie with treatment/prescription questions
My dad was just diagnosed with LBD. The neurologist has started him on the Namenda regimen. I had a couple of questions.

Is it standard practice to prescribe Namenda alone instead of in combination with a cholinesterase inhibitor like Aricept? I ask because I read somewhere that cholinesterase inhibitors were the "gold standard" for treating LBD.

Also, a study came out in April that seriously questioned Namenda's effectiveness with Alzheimers patients (http://www.alzheimersweekly.com/content ... dle-stages). Although I know LBD is a different disease that Alzheimers, they seem to be very similar and the treatment regimens seem to be similar (from what I've read so far on the internet). Accordingly, is there any concern that Namenda is also ineffective for LBD? Am I mixing apples and oranges?

Thanks, Joe


Mon Jun 20, 2011 10:38 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: Newbie with treatment/prescription questions
Hi Joe,

That was an interesting study. (I assume you are talking about PubMed ID#21482915.) It wasn't that Namenda was proven to be ineffective, it was that Namenda was shown not to be helpful in mild Alzheimer's. ("Conclusion. Despite its frequent off-label use, evidence is lacking for a benefit of memantine in mild AD, and there is meager evidence for its efficacy in moderate AD.") I think some individuals with mild AD did find benefit.

I'm not sure a group of LBD experts could agree on "standard practice." But we have heard here that many MDs do prescribe Namenda alone. (You can do a search on the term "Namenda.")

The one MD who has published his own treatment regimen for DLB is Dr. Brad Boeve. Have you read his "Continuum" paper from 2004? It used to be on lbda.org. No idea if it's still there after the latest website change. But you can try a search. You might investigate what Dr. Boeve says about Namenda only; he may cover that topic in his paper.

Two additional points about clinical trials... First, because the diagnostic accuracy of AD is low (one study showed 50% accuracy), many of these trials are thought to have DLB and VaD dementia patients thrown in. Some wonder if, in the past, the clinical trials on the AChEIs (such as Aricept) did so well because there were a good number of DLB patients included! (DLB patients respond better to AChEIs than AD patients.)

Second, this is only one study. AChEIs have not performed well in certain studies but these medications ultimately were approved by the FDA. So, one study is not hugely important.

Robin


Mon Jun 20, 2011 10:59 pm
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Joined: Fri Dec 31, 2010 3:07 pm
Posts: 1039
Location: Minnesota
Post Re: Newbie with treatment/prescription questions
Welcome Joe.

The article that Robin refers to is here: http://lbda.org/feature/1347/diagnostic-review-and-medicine-management-of-dementia-with-lewy-bodies.htm It may get relocated from time to time; save it to your own computer for easy reference.

Dr. Boeve treats my husband. He was very careful to start only one medication at a time. He asked which symptoms were most problematic and worked his ways through them one by one. I think it took about a year to have the full protocol in place. The results were worth it.

It is hard to be patient. There are so many symptoms and so many drugs. Each patient reacts differently. There isn't a magic combination that is right for everyone. Do you attend medical appointments with your dad? Don't hesitate to ask the doctor to explain his choices.

_________________
Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Tue Jun 21, 2011 1:29 am
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