Friday, September 15, 2017

Is Namenda ‘neuroprotective’?

A couple of years before I was diagnosed with Alzheimer’s, one of my doctor’s, a gerontologist—I was 53 at the time—prescribed Aricept. The clinical name is Donepezil, and it’s likely that my gerontologist strongly suspected that I already had Alzheimer’s or some other emerging form of dementia. In the ensuing months, I underwent  a neuropsychological examination and, despite my eroding short-term memory, my neuropsychologist pronounced that I was functioning at a high cognitive level. When she asked me to discuss a current event (this was the early soring of 2014) I chose the Putin regime’s meddling in the Crimea—the region that Russia and other great powers have vied for influence for centuries. I didn’t say it quite that way—I would have been more articulate in writing—but the doctor pronounced that I was “functioning at a high cognitive level.”
My relief was significant but premature. What the doctor was subtly conveying was that despite my weak short-memory, I was otherwise doing quite well. Later I learned about “cognitive reserve,” the phenomenon that benefits some people with Alzheimer’s, particularly among people with high levels of formal education. While cognitive reserve can be helpful, it can’t confer much protection in the short-term memory sphere, which is typically the first realm of the brain to show decline. A few weeks before I was diagnosed, I had a premonition. I was discussing something with my editor, and I was struggling to grasp what he wanted me to do. I didn’t quite formulate my thought this way, but the sense was, this is what dementia is.
The gerontologist delivered the bad news a few weeks later. That she had prescribed Aricept, the most widely prescribed medication for Alzheimer’s, before I was diagnosed, spoke to her confidence that I already had the disease. But Aricept did not sit well with me. Perhaps I didn’t give Aricept a chance. But after having an intense nightmare that had an almost psychedelic quality to it, I decided to leave my Aricept in the medicine cabinet. For a time I took the drug at a reduced dose, but I decided to go down a different road. By now, I’d learned that regular daily exercise—in my case, swimming, vigorous walking and cycling—could help slow down the disease’s pace. And, no longer employed, I have time to exercise. The exercise, in turn, led to good sleep habits. Sometimes I disturb Paula’s sleep, but that’s another story, still in progress.
A couple of weeks ago, though, my gerontologist noted that another Alzheimer’s drug—memantine—has shown some efficacy in clinical trials. The brand name is Namenda. According to the website drugs.com, Namenda “reduces the actions of chemicals” in the brain that may contribute to the symptoms of the disease. But if you have the patience, there is a little nugget waiting to be exhumed. The paragraph begins discouragingly, pointing out that there is scant evidence that this drug can help people still in the mild or moderate stage of the disease. But there is a “very small but statistically significant effect” from Namenda over six months involving cognition, according to the study. The basic question remains whether Namenda can help people in the early and middle stages of the disease.
 According to a study with 431 participants, there was “no substantial benefit” by taking Namenda. If this is progress, I must be blind to it. But there is at least one thing in Namenda’s favor, at least for me: In the two weeks since I’ve been taking Namenda, I’ve continued to sleep well. That was not the case with Aricept. Nor have I experienced significant dizziness, said to be a common side effect of Namenda. But to be honest, I am not optimistic. Researchers have been studying Namenda since at least 2003, and there is yet no hard evidence that people like me can benefit from this particular drug. It’s a stretch to call that “progress.”

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