Treating moderate to severe disease

Memantine (Namenda) is approved by the FDA for treatment of moderate-to-severe Alzheimer's disease. It blocks the neurotransmitter glutamate from activating special receptors on nerve cells, keeping the cells healthier. Memantine is the first drug to be approved for moderate-to-severe dementia; the cholinesterase inhibitors currently are approved only for mild-to-moderate symptoms.

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Clinical studies have found that patients with moderate-to-severe Alzheimer's disease who took memantine performed better on scales measuring the common activities of daily living such as eating, walking, using the toilet, bathing, and dressing as compared with patients on placebo. The lower-functioning patients may benefit the most.

Memantine appears to be safe and effective alone or when used together with a cholinesterase inhibitor. However, as with the cholinesterase inhibitors, the effect on cognition and abilities is modest and may decline after about six months. Research is ongoing to determine long-term benefits.

Memantine is thought to play a protective role in the brain by regulating a chemical messenger called glutamate. Glutamate plays a key role in learning and memory by acting as a kind of "gatekeeper" of some of the brain's other chemicals--allowing certain amounts of these other chemicals (such as calcium, which is required for information storage) to enter the brain's nerve cells. Allowing too much calcium into the nerve cells can damage and destroy them. Memantine keeps the glutamate under better control, which keeps the calcium under better control, which helps keep the brain's nerve cells functioning more normally.

Very few side effects have been reported by patients taking memantine. From the clinical trials, the most commonly reported side effects--and those that were reported at a frequency 2 percent or more than placebo recipients--include dizziness, headache, and constipation.