Understaning Memantine (Namenda®):

What You Should Know about its Role in Alzheimer's Care 

 

Memantine is a medicine approved for moderate to severe Alzheimer’s disease. It works by protecting brain cells from too much stimulation of a chemical called glutamate, which can damage memory and thinking cells. It is not a cure, but it may help slow down memory loss and problems with daily activities. Here’s what seniors and caregivers need to know: 

 
WHAT THE EVIDENCE SHOWS: 

  • Mild AD: Little-to-no benefit found in this group(1,2).

 

  • Moderate-severe AD:  Benefits are small, but consistent & meaningful, such as:

    • Number Needed to Treat for various outcomes (10):

      • 3 and 6 for global outcome integrating cognition, daily activities, behavior, overall clinical impression, caregiver observations

      • 7 for cognitive outcome on ADAS-Cog and SIB assessments

      •  4 and 8 for activities-of-daily-living (ADL) outcomes

    • Can sometimes lessen agitation, aggression, or irritability (12, moderate quality evidence)

    • When memantine is taken together with another medicine (donepezil), people were able to stay at home longer before needing full-time care (11, observational, less robust evidence)

 

  • Combined treatment, memantine + cholinesterase inhibitors, may yield slightly better results than either alone. The combination therapy  did not reliably achieve better outcomes than cholinesterase inhibitor alone. (3,5)

 

  • Side effects are few and rare (e.g., dizziness, headache), so most people tolerate memantine well. (6,7)

 

  • Some reviews suggest limited real-life impact despite statistical gains.

 

KEY takeaway

 

Memantine can help slow memory loss, behavior changes, and loss of daily skills somewhat—but mostly for people in the moderate-to-severe stages of Alzheimer’s. (3,8,9). It doesn’t make a big difference, and it doesn’t help much when the disease is mild. Often, doctors use it alongside other medications for a bit more benefit. The good news is that it’s usually easy to take and rarely causes serious side effects.

 

 

 

PRACTICAL TIPS

 

Give it time: benefits may be gradual over weeks to a few months.

 

Keep routines: pair medication with steady sleep, activity, and meals.

 

Watch for side effects: dizziness, constipation—ask the clinician if they appear.

 

Combine approaches: medications + lifestyle steps may help more than either alone

 

Reference List

1. McShane R, Westby MJ, Roberts E, Minakaran N, Schneider L, Farrimond LE, Maayan N, Ware J. Memantine for dementia. Cochrane Database of Systematic Reviews. 2019;3(3):CD003154.
2.Schneider LS, Dagerman KS, Higgins JP, McShane R. Lack of evidence for the efficacy of memantine in mild Alzheimer disease. Archives of Neurology. 2011;68(8):991–998.
3.Reisberg B, Doody R, Stoffler A, Schmitt F, Ferris S, Möbius HJ; Memantine Study Group. Memantine in moderate-to-severe Alzheimer’s disease. New England Journal of Medicine. 2003;348:1333–1341.
Matsunaga S, Kishi T, Iwata N. Memantine monotherapy for Alzheimer’s disease: a systematic review and meta-analysis. PLOS ONE. 2015;10(4):e0123289.
(Meta-analysis showing small but consistent improvements in cognition, behavior, and daily functioning.)

4. McGleenon BM, Dynan KB, Passmore AP. Acetylcholinesterase inhibitors in Alzheimer’s disease. British Journal of Clinical Pharmacology. 1999;48(4):471–480.
(5. Schmitt FA, et al. Efficacy of combination therapy with memantine and donepezil vs donepezil alone in moderate to severe Alzheimer’s disease. Alzheimer’s & Dementia. 2006;2(4):212–221.
6. Wang R, Reddy V, Sharma S. Memantine. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
7. Tan CC, et al. Efficacy and safety of cognitive enhancers for Alzheimer’s disease: a network meta-analysis. Alzheimer’s Research & Therapy. 2014;6(2):48.
8. Herrmann N, Gauthier S. Diagnosis and treatment of dementia: 6. Management of severe Alzheimer disease. CMAJ. 2008;179(12):1279–1287.
9.Doody RS, et al. Practice parameter: management of dementia (an evidence-based review). Neurology. 2001;56(9):1154–1166.

10. Livingston G, Katona C. The place of memantine in the treatment of Alzheimer's disease: a number needed to treat analysis. Int J Geriatr Psychiatry. 2004;19(10):919-925.

11. Wong, J., Bansback, N., Lee, P. E., & Anis, A. H. (2014). Cost-effectiveness of memantine as an adjunctive treatment for moderate-to-severe Alzheimer’s disease in Canada: A Markov model. Journal of Medical Economics, 17(6), 416–426. https://doi.org/10.3111/13696998.2014.914013

12. Wattmo, C., Minthon, L., & Wallin, Å. K. (2013). Long-term use of cholinesterase inhibitors and memantine in Alzheimer’s disease: A real-world observational study on predictors of treatment and outcomes. Alzheimer’s Research & Therapy, 5(1), 1–14. https://doi.org/10.1186/alzrt7